Question on Orgovyx.

[AlmostnoHope]

When does an Oncologist in these days prescribe Orgovyx and will he let you do it instead of Lupron from the start. Thank you. I don't have any trouble getting it but others seem to have to have undergone treatments before they ever can get it.

[Havanablues]

I was supposed to start Lupron, but did a little research and asked for Orgovyx and oncologist checked my insurance and it was approved.

[Pjford in reply to Havanablues]

I heard recovery on Orgovyx is much quicker than Lupron regarding libido once finished? My question would also be, are the side effects the same ?

[jackwfrench in reply to Pjford]

Hello, I had not heard libido returns faster on Orgo once finished with ADT, is that what you mean?

[dhccpa in reply to jackwfrench]

T recovers faster. Does libido automatically follow? One would hope so, but I haven't done it, and very few have been on just Orgovyx for 4-5 years or more thus far. But it will be interesting to hear from them.

[kreg001]

I just asked this a few days ago. The PA I was talking with said if I had any heart issues, which I don’t, Medicare would approve Orgovyx. He didn’t think it was worth a try at this time.

[dhccpa in reply to kreg001]

Medicare Advantage? Or your Plan D pharma plan? It's in my Plan D formulary, so I could take it for about $2K per year.

[Still_in_shock in reply to kreg001]

Same heart issues with Orgovyx as Lupron.

[AlmostnoHope in reply to Still_in_shock]

I'm not feeling the same heart pull as I did with Lupron personally.

[Jluh]

Interestingly, when I started ADT I was offered the choice of which before having a regimen of salvage radiation (2022). I chose Orgovyx as I felt a pill was easier and I wouldn't have need to go get shots every 1, 3, or 6 months. Was approved in a program paying all but $10 every refill. After 5 weeks and readying for radiation testing showed my T level still above 250. It was not effective for me. So I had Firmagon shots for 1 month, T level down to under 20 in 3 days. Then I went to 6 month Lupron along with Abiraterone. ---- some decisions may be based on insurance or program approval - some on ability to consistently take the medication, a shot means no skipped intake - other considerations are heart issues in particular, Orgovyx shows less impact on this. It's a discussion with your doctors. My Cardiologist reviewed the original and subsequent decisions as I have a mitral valve prolapse along with bradycardia and he is always involved.

[dhccpa in reply to Jluh]

Interesting that Orgovyx was not effective. That's the first report I've seen of that.

[chefjlu in reply to dhccpa]

My oncologist has several patients where it was not effective. We're all a bit different and our reaction to medicines vary. Always important to keep communication open.

[Spinel_Cutter]

I don't like Lupron. Orgovyx has a better adverse effect profile, less cardio issues, and faster rebound after going off it. Regardless of what "I like," Ocnco 1 said: Here's the menu: Lupron for two years + IMRT. Onco 2 said the same, "Your insurance won't pay for Orgovyx."

I consulted with Alicia Morgans of Dana Farber and threw out my research data. I felt that Orgo + Abi (for 1 year to 2 years based upon Decipher test results) with IMRT then Brachytherapy would give me the best 10-year survival results. Her response pretty much was, "yes, good plan."

I'm Gleason 4+4 (had PSA 54 when discovered) ~5mm extra-prostatic extension to the pelvic sling, but negative to lymph nodes, or seminal vesicles, or elsewhere (PSMA).

I was prepared to buy Orgo + Abi from India (at about $210/month) but am on some plan now and it's totally free. Adverse effects are ho hum, but at 6 weeks my PSA dropped from 50 to 0.8.

Now, I'm doubting if I'll do pelvic node irradiation but just may go straight to brachy. It seems that the pelvic node irradiation might give me a 10% better chance of a 10-year survival, but at what cost? I can just imagine what life would be like with by nads swollen to the size of baskeballs. (worst case lymphadema) I'm 75, and a 80% chance of survival with my path is good enough, I think I'll pass on lymph irradition for a 86% chance of survival to 10 years. I don't believe that lymph node irradition in my case is worth it for a +6% survival chance at 10-years, especially in the light of the now available PSMA-pet scans, which I think will become cheap in a year or two (You can get them in Belgium with the F-18 tracer now for $800, versus $29,000 in America.)

OP you wrote, "... will he let you do it instead of Lupron from the start." If both options are appropriate for you and your cancer, ultimately it's up to you, but it took me a few trips to oncos to get past the, "I'll let you..."

To the best of them, you are simply a medical record number, one of many, maybe hundreds. To you and yours, you are 1 of 1. Remember that. Find a path that you think is wise and a doc that will work with you. (And yes, I realize, it ain't always that easy).

[AlmostnoHope in reply to Spinel_Cutter]

Thank you so much.

[Hawk56]

In my experience, when you ask for it. As to the question "will let you do it", unless he has a medical issue with it, he is not the majority shareholder in the decision.

In April 2023 when my labs and imaging showed our decision criteria for going back on treatment, they thought I would do Lupron again. I said no, wanted to do Orgovyx this time.

They had no issues putting the prescription in,

I think their concern was the financial toxicity. I have TRICARE For Life which also functions as Part D, no issue, my co-pay for 90 day supply was $68. They were surprised at that.

We generally understand the advantages and disadvantages:

Lower CV side effect profile

No Flare

Faster to castration

Higher sustained castration

Faster recovery of T when stopping.

Requires disciple to take daily

Financial toxicity.

Kevin

Clinical History

[AlmostnoHope in reply to Hawk56]

Thank you so much.

[PELHA]

Yep when I ask our MO about switching he does mention the cost and says hubs doing well on the Lupron.

[kreg001]

thank you for sharing

[Explorer08]

I started with Orgovyx and added Xtandi after a couple of years. Working well so far. No problem getting either. I never did do any of the injectable ADT meds.

[AlmostnoHope in reply to Explorer08]

Thank you

[mababa]

Almostnohope, once you're diagnosed with PCa, your oncologist can prescribe which ever ADT regimen is recommended. Yes, you can definitely ask for Orgovyx, but you should check to see whether your insurance will cover it. It's not cheap otherwise. Clinics prefer to prescribe something they can administer within the clinic. It's more profitable for them and some MOs think they have better control on making sure you get the drug. I'm on Medicare with a gap drug plan. Med would have covered Lupron 100% because it's administered within a hospital/clinic. Luckily, my drug plan limited my out of pocket expenses to $3000 for the year. Basically, I maxed it out so they covered everything after that. Retail price of Orgovyx is about $2700 per month.

When I was first diagnosed, it was my radiologist who went through the various ADT regimens available to me, in advance of RT. She included Orgovyx because a person can recover more quickly from it versus Lupron when (and if) you go on vacation in the future. Also, SEs are said to be less severe. Can't verify that. That's about all I know. Good luck and best wishes in your battle with PCa.

[AlmostnoHope in reply to mababa]

Thank you most sincerely.

[j-o-h-n]

When does an Oncologist prescribe Orgovyx instead of Lupron from the start.

ChatGPT said:

An oncologist may prescribe Orgovyx (relugolix) instead of Lupron (leuprolide) from the start based on several clinical considerations, including:

Faster Testosterone Suppression – Orgovyx achieves castrate levels of testosterone faster (within days) compared to Lupron, which takes weeks. This is beneficial for patients needing immediate androgen deprivation, such as those with aggressive prostate cancer or high disease burden.

Lower Risk of Cardiovascular Events – Studies suggest Orgovyx may have a lower risk of major adverse cardiovascular events compared to Lupron, making it a preferred choice for patients with a history of heart disease or risk factors like hypertension, diabetes, or prior heart attack.

Oral Administration – Orgovyx is a daily oral pill, while Lupron requires an injection (monthly, quarterly, or every six months). Patients who prefer oral medication or want to avoid injections may be started on Orgovyx.

Avoiding Initial Testosterone Surge ("Flare") – Lupron initially causes a temporary rise in testosterone before suppression, which can worsen symptoms in patients with bone metastases or high disease burden. Orgovyx directly lowers testosterone without a flare, making it a safer option in these cases.

Flexibility & Reversibility – Since Orgovyx is taken daily, stopping treatment leads to a faster testosterone recovery compared to Lupron. This can be useful for intermittent therapy strategies or when rapid reversibility is needed.

An oncologist will weigh these factors based on the patient’s cancer stage, cardiovascular health, treatment goals, and personal preference. Would you like details on clinical studies comparing these drugs?

If you have Almost no Hope then laugh your ass off instead.

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Thank you so much.

[Notafan123]

My husband was given a 1-month Firmagon injection initially. Insurance company was slow to approve Orgovyx. They did finally, but the oncologist didn’t want him switching meds mid-chemo so he stayed on Firmagon for 6 months then switched to Orgovyx for the last 6. We did not notice any differences in side effects. However, we did notice that the Firmagon did not wear off for 4 months after the last injection. So those shots last far longer than the stated time period. The scar tissue in his abdomen from the injections was still visible and substantial 9 months later on CT. He recovered quickly after Orgovyx - his T was back in the normal range within 3-4 months and started going up right away once he was off the meds. Hope this helps!

[AlmostnoHope in reply to Notafan123]

Thank you.