Synopsis: Ten days ago I completed my regimen of 28 RT treatments. I am due for my second 6-month Eligard shot in about 4-6 weeks. I had been on Zytiga/Prednisone 5mg for about nine weeks before my MO took me off of it due to high blood pressure. In my bio I mentioned that I was recently hospitalized for three days due to a blood clot in my lung - my doc feels like it may have been precipitated by the Eligard.
1. When I see my RO in a couple of weeks I would like to have good science and rationale for the (hopefully) best ADT drug for my situation.
2. A different RO and my PCP suggested that I should be "fine" without any MO drug, based on my Prolaris Boiopsy Test Report. That report indicated that I am a good candidate for:
a.Single-modal (SM) treatment (RT or surgery): the 10-year risk of PCa metastasis with SM treatment is 3.9%.
b.Multi-modal (MM) treatment (RT with ADT): the 10-year risk of PCa metastasis with MM treatment is 2.4%. The RO said those are very good numbers.
So, when I see my MO I plan to tell him I don't want to be on Zytiga or any alternative to Zytiga due to all the research that I've seen indicating that all of them carry some sort of heart issue: heart attack, stroke, death.
Back to the main question now, I also see that many of the ADT drugs have similar potential heart-related issues. Does anyone know of an ADT drug that does not carry heart-related issues?
My, and the docs I consulted with, have this rationale: my risk for metastasis over ten years is from 2-4%. Any thoughts and/or rebuttals to this logic, of staying off any MO drugs and searching for a "heart-safe" ADT? So, having a stable thoracic aneurysm and a blood clot (treating with Eliquis) I am reluctant to add a heart-risky drug to the mix.
I have not received a current PSA or testosterone test since starting my treatments, when it was 10.0. I plan to call my RO tomorrow to request this test.
Thanks.
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y_o_g_i-2024
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ADT can definitely affect heart functions. It can lower EF fraction 25% to 30% putting one in heart failure so make absolutely sure your situation warrants it. I know because it happened to me. When I got off of it, my EF fraction rose to 52% . Keep on the Eliquis as it prevents Deep Vein Thrombosis which is common with ADT.
I don't think Eligard increases clotting - if anything the opposite - because it can reduce hematocrit levels. That said, I don't see why someone with favorable intermediate risk PCa needs any adjuvant hormone therapy.
Thanks for your thoughts, which made me dig a little deeper into my reports - things I haven't looked at very closely until coming to this group.
Does the following alter your perspective for my situation on hormone therapy:
1. From the Prolaris Biopsy Report:
a. Clinical T stage: T1c
b. % Positive Cores: >= 50%
c. Gleason score: 3+4
d. NCCN risk: Unfavorable Intermediate
2. From my MRI: PIRADS 5
I don't know enough at this time to understand the above reports. So, I just depended on the RO and MO but would really like to avoid drugs that might be considered cardio toxic.
It would seem that I need ADT to keep the testosterone down. My follow-up with the RO is Mar 4 and I will be having the PSA and full blood workup - my first since stopping radiation about two weeks ago.
Also, when I met with my RO after the above reports were in he believed this was "curable."
Yes, it does alter my perspective. Since you had > 50% positive cores (I assume that multiple cores from the same PIRADS 5 area weren't counted as separate cores), that puts you into the unfavorable intermediate risk category. Short-term ADT will improve your outcome. I don't understand why you are getting Zytiga.
My husband recently discontinued Zytiga and Prednisone, after being on it for a year due to concerns re: cardio toxicity ...he has a growing aortic root aneurysm and moderate to severe aortic valve regurgitation. He is still on Orgovyx,( 15 months so far)...blood pressure still unstable even with added beta blocker and Losartan.
Why was ADT recommended for you in the first place?
Thanks, I will add Estradiol to my list of topics to discuss with my RO on Mar 4. I see one side effect is weight gain - I would dread that as the other meds I was on caused a 25 pound weight gain and am working now to drop those pounds.
perhaps I missed it in your bio but how old are you? In my thinking using 10 years at low risk plus your age may give you a good answer to your question.
Orgovyx studies indicate that it is the most heart safe ADT drug. Many cancer centers now have a Cardio Oncologist available that can answer your questions and assist with your concerns. Also they are a great resource for a second opinion. In my case I was just taken off ADT at fifteen months as the cardio risks were overtaking the ADT rewards at this time. Was originally shooting for twenty-four months. If I had been on Lupron I was originally told six months max would have been pushing my luck. If I was very low risk I would avoid ADT.
Hi, l believe you have a good handle on your condition. I was only on Eligard every 6mths and Lupron for 4yrs. The doc stopped treatments in 2022 with a PSA of 0.01. I have maintained that low score currently.My problem with ADT treatment was osteoporosis. I was not advised to take calcium, vit d3 etc to prevent osteoporosis. Now, l have to have Prolia injections every 6mths and that can have serious side effects.
MY GUESS WOULD BE PLAIN OLD HUMOR (BUT WHAT DO I KNOW?)
ChatGPT said:
Androgen deprivation therapy (ADT) drugs are commonly used to treat prostate cancer, but they can have varying effects on cardiovascular health. When considering a heart-healthy ADT option, the goal is to minimize the risk of cardiovascular complications while effectively managing testosterone suppression.
Best Heart-Healthy ADT Options:
Relugolix (Orgovyx) – Best for Cardiovascular Health
A newer oral GnRH antagonist.
Lower risk of major adverse cardiovascular events (MACE) compared to GnRH agonists like leuprolide.
Rapid testosterone suppression and faster recovery upon discontinuation.
Shown to reduce cardiovascular risk in men with pre-existing heart disease (compared to leuprolide).
Degarelix (Firmagon) – Another GnRH Antagonist
An injectable alternative to Relugolix.
Also associated with a lower cardiovascular risk than GnRH agonists.
Can cause injection-site reactions but may be safer for patients with high cardiac risk.
Higher-Risk ADT Options (To Be Cautious With):
Leuprolide (Lupron), Goserelin (Zoladex), Triptorelin, and Histrelin (GnRH Agonists)
These can cause an initial testosterone surge ("flare").
Linked to higher cardiovascular risk, particularly in men with pre-existing heart conditions.
Associated with an increased risk of blood clotting, stroke, and heart attack.
Key Takeaways:
Relugolix is the preferred choice for men with cardiovascular risk.
Degarelix is another option if an injectable form is needed.
Avoid GnRH agonists (like leuprolide) in high-risk patients.
It was studied years ago -- what is the biggest risk? Sedentary vs Obesity vs Smoking. The answer: sedentary. Applicability to PCa? I'd substitute PCa for smoking. Exercise -- three ways. Cardio, aerobic, and resistance/lifting. How much? 1-2 hours per day is what I do. Of course it doesn't hurt to stop smoking too.
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