Treatment recommendation

[dlste353]

Soon starting 18 months of ADT and salvage radiation and my Oncologist is giving me the choice between Lupron/Casodex or Orgovyx. I'm leaning towards Orgovyx. Does anyone have any thoughts between the two? Thanks!

[Magnus1964]

My first question is, why the limit of 18 months on an ADT drug? How does this doctor know how you will be reacting to the drug at the end of 18 months? If you're doing well at that time, stay the course.

To answer your question, I would start with casodex. It's an older ADT drug with less side effects. If at some time in the future it fails, you can move to other ADT drugs, i.e. zytiga or xtandi.

[MateoBeach]

Since you mention 18 month ADT regimen, I will presume that this is an additional (adjuvant) therapy in support of curative intent radiation therapy. A sound idea to pursue to make the RT more effective.

I favor using an LHRH antagonist, either daily Orgovix (more expensive) or monthly Firmagon over the LHRH agonists (Lupron, Eligard and others) because they have better cardiovascular risk profiles.

Here to fore either can be used. And usually bicalutamide is added for the first month to cover testosterone “flare” when agonists are started. However, here is another approach that appears to work even better: starting an agonist such as Lupron at the SAME TIME as beginning the RT, and NOT adding bicalutamide. It appears the testosterone flare may actually make the cancer more susceptible to the radiation and produce even better results. Worth discussing the following article with your RO or MO.

ncbi.nlm.nih.gov/pmc/articl...

[NPfisherman in reply to MateoBeach]

MB,

It is my n=1, we will see what happens, but I went with Eligard (what the insurance would pay for) started 36 hours before taking SBRT. Testosterone flare for Lupron and Eligard is 5 to 12 days. I completed my treatments in 1 week, and now on abi and prednisone. Hoping this works well for me....will be doing a PSA next week... Hope all is going well for you....

Fish

[MateoBeach in reply to NPfisherman]

That is very good. You are within the time window for This benefit from androgen flare. Hoping for the best for you, of course, Fish. Paul

[dlste353 in reply to MateoBeach]

Thanks so much for your reply

[NPfisherman]

I agree with MateoBeach. If this is in addition to radiation treatment, then it may/should depend on cardiac risk factors...if you have issues controlling high blood pressure and issues controlling your cholesterol, especially LDL, then Orgovyx may be a better choice for you. As I found out, it is not what you want though, it is what the insurance will agree to PAY for in treating your PCa. Don't get me started on this dark path...

I take it you had a Pylarify scan to rule out metastatic disease?? If not, then talk to your RO about it. That way, if you are oligometastatic, you could get SBRT as well.

Best of luck,

Don Pescado

[dlste353 in reply to NPfisherman]

Thanks so much. Luckily my insurance will cover either, although the copay for Orgovyx is quite high.

[cujoe]

dlste - I would agree with the great fisherman who is also an NP - that trying to get a PSMA scan early on is a major advantage in formulating/directing your treatment strategy. Having a handle of disease extent now is key to choosing the most effective treatment.

Best of Luck with the RT + ADT. Also see mateobeach's recent post about timing of ADT and RT. I would print this off and get it to my MO/RO before starting the Salvage RT. Just my 2 cents opinion. Link to mb's post:

Testosterone “Flare” (Or Testosterone?) Timing to Optimize Salvage Radiation Therapy

healthunlocked.com/fight-pr...

Keep it Safe & Well! Ciao - Captain K9

[dlste353 in reply to cujoe]

Thank you for your reply. Yes I have had a PSMA scan.