Can someone recommend a good oncologist to consult with remotely regarding intermittent ADT?

[Farmhand]

....For stage prostate cancer… After Eligard for 10 months PSA is .9 and alkaline phosphatase is normal....One month ago switched to Orgovyx with no break between Eligard and Ogovyx . Have only one functional kidney and GFR has been at approximately 80 but since switching to Orgovyx, GFR is now 69 accompanied by intermitted kidney pain which worries me, creatinine levels are also raising somewhat. Switched to Orgovyx to start on intermitted ADT but did not consider the overlap of these two drugs seeing as Eligard stays in the system for many months. One is an agonist the other is an antagonist but both have similar effect.other ADT side effects/symptoms have also become much more pronounced this past month: shortness of breath, joint pain, muscle pain, etc....can live with all of these but not live with decreased kidney function. Finally found research papers that show ADT can cause acute renal failure especially with patients who are already compromised in this arena.

Anyone else had similar issues? And can someone recommend a good oncologist to consult with remotely to begin intermittent ADT?

[Hidden]

Hey Farmhand. First off, what a team you have here.! I’m sorry about the kidney. That does take top priority to protect. I had k failure from pc tumors blocking bladder and urethra. Tubes and a foley for almost two years. Internal stents at the end.I know the role of the kidney! I Don’t have the answers . Others will chime in I’m sure. Adt for me is devastation. Six yrs no t for me . I understand wanting a break. I disliked the Lupron so much that I did an orchiectomy 2017. So there there is no return to natural t for me . I’d have to inject. Doc says that could wake the tiger that has been dormant hiding out of view. Whatever you do . Enjoy those dogs . Good luck on protecting the kidney . Scott

[cesces]

You may have trouble getting a remote consult from many docs without first a face to face.

Maybe your local doc could get such a consult.

Try Dr. Sartor at Tulane. He does do remote consults with patients whom he has seen before.

Ask him for a consult on bipolar androgen therapy and straight androgen therapy.

Talk to his assistant to be able to email him your history as part of the request.

You will end up with a full second opinion.

Where are you geographically located?

[Farmhand in reply to cesces]

Thank you...I am located in northern New Hampshire on the Canadian boarder.

[cesces in reply to Farmhand]

I think you are really going to have to travel in order to access the specialist care that you need.

I would get a consult from Mayo clinic and from Dr. Sartor at Tulane.

Mayo is the best at cross disciplinary care, which is what you need.

Sartor is the best at cutting edge treatment.

It would be best to start with Mayo, but it will take you a long time to get an appointment with them.

[MateoBeach]

Testosterone cannot be lowered below or even to zero with either or both ADT. Orgovix is most suspicious for the kidney function deterioration due to the timing. So I would be inclined to stop that now. As you say, T will not recover for many months from the Eligard anyway. If you have a referral letter for consult from a current doctor, they may not require a face to face to give an opinion. Do you have an internist? A nephrology consult sounds appropriate. Great dogs!

[Farmhand]

Thank you for the great advice. We will talk with our urologist about connecting with a nephrologist as soon as possible… This is been our inclination also....interesting that no MD seems to guide us in that direction🤔And yes we can certainly get a referral letter. Does Dr. Sartor in Tulane advise on IADT as well as BAT?