Intermediate Unfavorable - Started on Orgovyx and then switched to Firmagon have not lowered my PSA now double therapy is this common?

[cnjaz]

You can look at my profile for my exact diagnosis. However I started on Orgovyx on June 19th and then I was switched to Firmagon and had the loading dose of that on August 28th. Here are my PSA numbers

June 19th 7.02 Testosterone 393

July 20th 5.95 Testosterone 141

August 28th 6.23 Testosterone 301

Sept 25th 6.93 Do not have that number yet but will post when I find out

The MO will now be adding Zytiga and Prednisone now or double therapy. Is this common? I am really concerned because it seems most of you have your PSA and Testosterone drop from being on ADT for as long as I have. Not sure what questions I need to ask or other therapy I should pursue. This whole thing has got me quite concerned and worried to say the least.

[Justfor_]

Well, IMO there are two possible explanations:

1) Your lab is in constant limbo. Try a different one.

2) Your "pituary to testes feed-back loop" is broken and ADT isn't working. Try instead an ARSI (Bica, Enza, Daro, Apo-lutamide) for 10 days to 2 weeks and if this won't lower your PSA (your T will most probably increase) than you are one of a kind.

[cnjaz in reply to Justfor_]

Thank you for your reply - this is one area I do not want to be "one of a kind". I will be starting the Zytiga or Abiraterone Acetate as soon as it arrives. I hope that works

[Justfor_ in reply to cnjaz]

Zytiga uses similar castrate mechanisms to Firmagon and/or Orgovyx.

Anti-androgens like the *lutamides work differently.

ChatGPT explains:

" Abiraterone acetate inhibits CYP17A1, an enzyme that is crucial in the production of androgens (such as testosterone) in the adrenal glands, testes, and prostate cancer cells. By blocking this enzyme, abiraterone significantly reduces the levels of androgens in the body. This is important because prostate cancer growth is often fueled by these androgens.

Traditional anti-androgens, like bicalutamide or enzalutamide, usually work by directly blocking androgen receptors, preventing androgens from binding to them. In contrast, abiraterone stops the body from producing androgens altogether, which makes it a key therapy for castration-resistant prostate cancer".

[cnjaz]

OK thank you so it sounds like this should do the trick for me - I hope. Also as for lab I use the one at MD Anderson so I assume they know what they are doing. Everything is done at their facility.

[Tall_Allen]

It is not common that doublet therapy is needed for localized prostate cancer. IDK why GnRH antagonists aren't working for you. I think you ought to consider adding apalutamide - it will strongly block testosterone that Zytiga can't stop from activating your prostate cancer.

I think brachy boost therapy (external beam radiation to a wider area + HDR brachy boost to the prostate) is more powerful than HDR brachy monotherapy and should be considered for you.

[cnjaz]

TA - Thank you for your insight and wisdom. I will ask about apalutamide and see what response I get. As for the radiation at one point he had me with Brachytherapy and IMRT but changed it to 2 treatments of HDR Brachytherapy. Based on where I am at he might change it again. His analogy to me is he wanted to leave my Pelvic are clear in case of recurrence. He told me that would limit what can be done if I ever have that happen. If it does come back he can "sniper shot" any lesion or lymph node. If I had my Pelvic are "carpet bombed" there are spots missed and radiation option is very limited. He felt he can get the cancer by doing whole prostate Brachytherapy.

[Mgtd in reply to cnjaz]

Interesting comment on carpet bombing. I suspect age and physical condition also may play a factor. At almost 80 I was offered whole pelvic radiation along with prostrate radiation. I believe the thinking was to get any micro cancer in the pelvic area and give a better cure option the first time. After almost 18 months post treatment I am waiting for the other shoe to drop. So who knows!

I have come to the opinion that it is all a “crap shot” using probability data to make it sound scientific and rational. They try their best and that is all we can ask for.

In any case my days are numbered but at your age perhaps a more wait and see approach is a better decision.

Good luck!

[cnjaz in reply to Mgtd]

Thank you! The RO said I was an active man and did not want to weaken my Pelvic area and wanted options in case it comes back. The ADT stuff is what is worrying me now just need to have something work and get the numbers down so I can get the radiation. However, I do agree with you this whole thing is a crap shoot that is for sure

[Mgtd in reply to cnjaz]

Small world. I retired to Flagstaff. One son in Chandler. One in Scottsdale. Good luck on your journey.

[cnjaz in reply to Mgtd]

Thank you I appreciate that a lot - I am in Chandler myself too

[dhccpa in reply to cnjaz]

TA doesn't normally read comments that aren't done as direct replies to him.

[cnjaz in reply to dhccpa]

OK I will try that. Thanks

[lpol83712]

androgen receptor blockers like darolutamide don’t block the production of testosterone but block its effect on the cancer cell receptors. Zytiga blocks the testosterone from adrenal glands where orgovyx or firmagon blocks the brain from stimulating the testicles to make testosterone There was recently published the study using estrogen patches to drop testosterone and treat prostate cancer with pretty minimal side effects. Not now standard of care but several options before chemo or pluvitco

[cnjaz]

Thank you I hope I do not have to resort to chemo or pluvitco since I am still not metastatic. However, I do not want to get there if I can help it either.