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.
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cnjaz
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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.
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
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".
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.
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.
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.
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Surgical castration?
The other side of ADT
Radiation levels. 
time to reach undetectable PSA after prostate removal 
