1 month vs 3 month HT injections

So I'll soon be embarking on my HT journey. The RO wants me to start on 14 days of Bicalutamide tablets, then 3 monthly injections of Eligard. So I have a few questions;

1: I remember someone mentioning on this forum that monthly injections are easier to tolerate compared to injections every 3 months. The reason is that with the 3-month injections, there appears to be an initial higher release of the drug in the first few weeks before it stabilizes and continues releasing the rest over the remaining 3-month period. Is this the case and has anyone also reached this same conclusion by experience?

2: Do tablets have similar intensity to injections, and could they entirely substitute for injections? While I understand they serve different purposes than Eligard, it seems Bicalutamide might have milder side effects than Eligard, yet over time, it might contribute to heart problems.

What are your insights on this?

Thanks all - have a safe and happy Christmas break.

[Tall_Allen]

1. Never heard that.

2. Orgovyx is strong. Bicalutamide is weak.

[Hidden in reply to Tall_Allen]

There was someone on this forum that said they couldn't cope with the 3 month injections and so went to the monthly injection and it was so much easier to deal with. I asked the RO as to what benefit there was to the having the 3 month injection and he said no benefit except for convenience. Naturally I'm happy to go monthly if its more tolerable.

Are you saying that Bicalutamide won't give to many SE's? - I'm assuming he wants me on these for 14 days before the injections as a stepping stone in prepping for the bigger gun!!

[Tall_Allen in reply to Hidden]

One anecdote on this forum guides your therapy?

A couple of weeks of bicalutamide prevents the effects of a testosterone surge. It is a weak antiandrogen that has fewer side effects and much worse cancer control. You can have zero side effects if you take nothing.

[Hidden in reply to Tall_Allen]

No definitely one anecdote will not determine my therapy TA, and so that is why I am asking the question, if others have had any adverse effects of the 3 month HT injection Vs the 1 month. At this stage no one has replied and so I'm going to assume that there is no difference in SE's between the 2.

I'm guessing that Bicalutamide tabs pre injections is a standard protocol.

[Tall_Allen in reply to Hidden]

It doesn't matter if 10 anecdotes were shared. All that matters are the statistics gathered when it was tested. It is standard, yes.

[Hidden in reply to Tall_Allen]

Thanks TA - yep makes sense.

[Benkaymel]

I've only been on 3-monthly ADT injections so cannot compare with 1-monthly but I have not noticed any initial problems in the few weeks after the injection.

I too had bicalutamide for 4 weeks when starting ADT to prevent testosterone surge - this is standard practice. The bicalutamide was actually quite effective in bringing PSA down quickly before I moved up to Xtandi.

[Vynbal]

Eligard (and lupron) whether 1 mo or 3, causes a surge of Testosterone when first started. Bicalutamide, an antiandrogen, prevents your cells - especially your Prostate Cancer cells from using this extra T. Orgovyx (Relugolix) is an oral medication that is used in place of eligard. Advantages are more rapid reduction of T at the start and much more rapid return of T at the end of therapy. Also there is no initial flare of T - so no need for bicalutamide. And there are fewer cardiac side effects- important if you have existing heart issues. And no injection issues.

The down sides of Orgovyx are primarily cost and compliance. It is very important that you never skip a dose.

Side effects from Eligard and Orgovyx are pretty much the same as they are mostly from having no T.

[Horse12888]

The way I understand it, re: drugs like Eligard, there is no such thing as "intensity." They either reduce your T to castrate levels or they don't.

[805guy]

If you can obtain Orgovyx, I would highly reccomend it. Yes, it is expensive however my prescription plan ultimately agreed to pay 70% after appeal by my urologist and the discount program through the company brought my copay to $0. Even if you have to pay some amount, I would absolutely do it. My T plummeted after I began taking it, just 2 weeks prior to 7 weeks of radiation. I was initially diagnosed with Gleason 7 (4+3), PSA 19.76 in April. Post radiation PSA is presently 0.05 with T at 11. Only side effects have been mild hot flushes every now and then. More of an annoyance and quite bearable. I am sure one day this drug will be the standard.

[taliesin1411]

Been on Tamsulosin and 3 monthly Zoladex for several years. PSA less than 0.1. My PC is restricted to Prostate gland. No noticable problems wih 3 monthly jabs. Luckily no radiation needed to date. I'm 77 years old and have major cardiac issues.

[lpol83712]

Biclutamide is a weak anti androgen used to block the testosterone flare with Eligard (it goes up before it goes way down). Biclutamide alone is generally not adequate. as a stand alone drug. The pills Orgovyx work as well as Eligard or better and biclutamide isn't needed as testosterone doesn't go up. The problem is generally orgovyx is quite a bit more expensive and not on all insurance or health plans secondary totally to cost. If you can get them covered that is ideal..