Castrate Resistant on Orgovyx, What's next?

[Startech]

My Psa sky rocketed the last 90 days from 0.48 to 2.54 while my Testosterone lowered slightly from 11.8 to 11.4. I think this is a clear sign of castrate resistance. Last scan 6 months ago showed slight uptake along the Vas Deferens on one side. Not sure if MO will do another scan, but at the last visit he said we could do Nubeqa, Xtandi or Zytiga next. What seems to be the popular way to go and is there something else I should ask the MO about. My best to you all, Thank you.

[Lost_Sheep]

Sorry to hear about your PSA rise while T is below castrate level. Those androgen blockers you named can work, but I have no clue as to which will be best for you. Discuss side effects likely with each and which side effects are least dangerous or inconvenient for you to tolerate and pick the one that fits your situation best.

What other treatments have you had? (What arrows have you already used from your quiver?) Any characteristics of your cancer that might suggest any different course of action that could be fruitful?

[Startech in reply to Lost_Sheep]

Thanks for your response. I had surgery and 2011. And then I had four of six rounds of docetaxel when I started the orgovyx 30 months ago.

[85745]

I am taking Nubeqa , said to have fewer side effects to which I agree...., so far 7 months in only mild hot flashes now and then. Just turn a fan on me - it works. Don't seem to get them if I'm out and about and active.

[Startech]

I spoke to a friend of mine who is on xtandi. Like myself he is on Medicare. And his biggest complaint is that Medicare requires him to also get lupron shots even though his testosterone remains at castrate levels. His onco tried to argue with Medicare against the lupron to no avail.

[j-o-h-n]

Hello Startech,

How old are you, and where are you located and being treated? Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Startech in reply to j-o-h-n]

I'm 64 and I'm being treated by the University of Colorado health.

[j-o-h-n]

Thank you for your quick response (and for being a Star)!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[Tall_Allen]

Consider one of these:

prostatecancer.news/2022/09...

prostatecancer.news/2023/05...

[Startech in reply to Tall_Allen]

Allen, thank you for responding. I appreciate you more than you know. I just got my scan results this morning and have an appointment with my MO this afternoon.1. Interval progression of disease with new metastatic soft tissue nodule within the right superior lateral aspect of the prostate surgical bed.

2. Increased size and activity of metastatic implant in the right external iliac region.

3. Multiple new metastatic implants within the right pelvic sidewall.

4. New osseous metastatic lesions involving the right acetabulum and ilium.

5. No additional metastatic disease.

6. Moderate left maxillary sinusitis.

If this means I'm metastatic, is Xtandi+ Orgovyx an option? I would imagine SRT should also be considered. I don't want to be out of line, but I find your input just as valuable as my MO's.

[Tall_Allen in reply to Startech]

Both of the links above are still an option - they were neg. for metastases only on conventional imaging. You can also have whole pelvic SRT.

[Startech]

Again, thank you for your reply. I had my meeting with my MO this afternoon. His first comment was that radiation was not an option due to the location of the lesions. He gave me three options.

1.Add Xtandi and Talazoparib to Orgovyx.

2. Add Zytiga or Xtandi to Orgovyx.

3. Add Olaparib to Orgovyx.

At the time I chose option 1. He stated that in the beginning I may feel like I have the flu for a few days. But after coming home and doing my research on Talazoparib, I have changed my mind. I'm already suffering the effects of anemia. I'm leaning towards just adding Xtandi. I'm too tired tonight to research Olaparib, but will look at that in the morning. Thanks again Allen.

[jazj in reply to Startech]

Just curious....

What was your PSA when you determined you were "recurrent" in 2014?

Why are you not considering Nubeqa instead Xtandi?

[Startech in reply to jazj]

I went from undetecable to .034 and retested and it was .031 back in 2017. Nubeqa is for castrate sensitive without distant mets, so we felt Xtandi was the best course. After 30 days my psa has dropped.

[jazj in reply to Startech]

When you say "Nubeqa is for castrate sensitive without distant mets" did you mean Nubeqa is less effective than Xtandi for metastic disease? Because as far as I know there hasn't been a clinical study comparing the two drugs that shows Xtandi has benefit over Nubeqa in having less severe side effects than Xtandi.

So I'm wondering what data you based your decision on that Xtandi would be the better choice? Or was it based on the lack of studies on Nubeqa with CRPC metastatic and therefore you didn't want to leave it to chance that Nubeqa was inferior? Or was it just an ease of insurance approval thing because Nubeqa is not approved by the FDA for your situation?

[Startech in reply to jazj]

Correct, I read several sites, but the Nubeqa site itself and my MO convinced me to go with Xtandi or Zytiga w. Prednisone. It's only been a month and I'm happy so far. Just some night time leg cramps are new .

[jazj]

I re-read your profile and the reason I'm so curious with your case is your early history is similar to mine so I'm interested in the background behind some of your decision points. Why did you forego salvage radiation therapy?

[Startech]

My research at the time did not show a benefit and I was young...