Switched from Lupron to Orgovyx, back to Lupron

[SF22]

I was on Lupron for approximately 7 years. I decided to switch to Orgovyx 6 months ago. I seem to have difficulty with the discipline to take pills at the same time every day.

I am switching back to Lupron, but my Urologist wants me to stop Orgovyx and take Bicalutamide for 14 days before getting the Lupron shot. My PSA has risen month after month.

My question is why stop the Orgovyx 2 weeks before the Lupron shot? I am also on Lynparza.

Early in my diagnosis ( approx. 6 years ago) I was on Bicalutamide. It was ineffective and switched to Abiraterone.

[Tall_Allen]

When you stop taking Orgovyx, it stops reducing testosterone immediately - its half-life is just 24 hours. Testosterone activates the androgen receptors (ARs) on the cancer cells and encourages them to grow and replicate. Bicalutamide blocks the AR so testosterone can't activate it. When you first start taking Lupron, it paradoxically causes your testosterone to temporarily surge to very high levels for 2 weeks. It is necessary to take bicalutamide for 2 weeks to prevent the AR activation.

[SF22 in reply to Tall_Allen]

Thank you TA. Since Bicalutamide failed in the past, should I continue the Orgovyx for the 14 days while taking the Bicalutamide?

[Tall_Allen in reply to SF22]

Brilliant! That will prevent your testosterone from surging when you start Lupron. Sometimes men start with a shot of Firmagon, but Orgovyx works too if you have the pills.

[SF22 in reply to Tall_Allen]

Thank you

[velobard in reply to Tall_Allen]

This is timely info for me. I'm going back onto Lupron tomorrow after nearly a year of Orgovyx. This sounds like a simple strategy, as long as it won't cause any other issues.

[MateoBeach]

True that! You don’t need the two weeks of bicalutamide before resuming Lupron since you have been on the Orgovyx. Testosterone does not recover to flare from a LHRH that quickly. It takes quite a long time, though variable. The urologist is just doing his:her standard protocol for starting it as an initial ADT regimen. It reminds us that continued management of APC should most often be managed by a medical oncologist and not a urologist who are mostly oriented to surgical issues. Though some exceptional urologists are certainly the exception. Yours gives me pause.