Will Orgovyx (relugolix) Reduce Prostate Cancer without Radiation?

I am on orgovyx 15 months now. Psa fell to undetectable in 3wks or less. Also taking generic zytiga. A few hot flashes and sweating and some fatigue. I have been resisting radiation not wanting to damage my current quality of life. The experts say the cancer will become resistant to adt sooner or later. There no long term studies on orgovyx as it was only approved Jan 2021 so they are just speculating on this one.

Neglected to say I had a2.3psa recurrence post surgery and the adt was the next step

If your cancer is in an advanced stage, I would look into adding an androgen-reception signalling inhibitor (ARSI) at least. ADT is the traditional treatment for prostate cancer; adding an ARSI is how everything has changed over the past few years.

Examples: abirateron (Zytiga), enzalutamide (XTANDI), apalutamide (Erleada), and darolutamide (Nubeqa).

It used to be that they waited to add an ARSI until the prostate cancer became castrate resistant, but the big TITAN study showed that adding apalutamide (at least) to ADT earlier made a massive difference in overall survival, so much so that they had to unblind the study before it was done for ethical reasons and let the placebo group switch over.
https://www.nejm.org/doi/full/10.1056/NEJMoa1903307

After reading the synopsis of the titan trial it seems conclusive that synergy is demonstrated. Do you know of any research that compares xytiga/earleda effectively ranking efficacy?

Unfortunately, I do not know of any studies comparing Xytiga and Erleada, but to be fair, I haven't needed to look. If there are any, they would have to be for your specific situation: localised or (oligo-)metastatic, castrate-sensitive or castrate resistant.

Erleada is the first ARSI they put me on (olgo-metastatic, castrate-sensitive), and together with emergency debulking surgery to the metastasis site on my spine, radiation and ADT, it's held my PSA at < 0.01 on the sensitive test for over 2½ years now, so my onco team and I haven't talked about any alternatives.

My radiation oncologist says that I'm in "remission", but I'd add a footnote that it's *medically-induced* remission — I don't know what would happen if I stopped the ADT and ARSI, and since I'm tolerating them well and living almost a normal, active life, I'm not interested in taking the risk of finding out.

Thanks for your post. I have Adavanced Prostate cancer and have been on ORGOVYX since 2021 with excellent results. PSA 0.02 I’m not sure if it would be a good idea or worth it to add another medication since the side effects of ORGOVYX are pretty extreme now? Any comments

Hi Mikejf:
Thanks for your response that you have been or Orgovyx for over three years. Did you have your prostate removed and did your PSA count increase after a period of time and then your PSA count went down after taking Orgovyx? Why didn't you have radiation treatments?

To All Others:

Thank you for your responses.

Nick

no radiation or surgery did 4 rounds chemo in fusion followed by ADT treatment PSA has been 0.002 since 2019

An ARSI can extend the effective period of ADT like Orgovyx by many years by delaying castrate resistance and then inhibiting its effects, but obviously the choice depends on your tolerance and other factors.

It's worth raising the topic with your onco team, at least.

In further reading, I've discovered that not all ARSIs have been approved for metastatic castrate-sensitive prostate cancer yet. I'm not sure of all the options, but that's one reason I'm on Erleada (the TITAN study demonstrated its efficacy for mCSPC).

Erleada isn't cheap. In Canada, it would cost close around US $4,000/month if I had to pay for it myself, which is eye-watering (by comparison, Firmagon or Orgovyx would cost about US $400/month if I had to pay). But I am convinced that it's one of the reasons my outlook for a long(er) life is so good right now, three years in.