I'm so sorry you're forced to make that choice. Here in Ontario, the cost of Orgovyx or Firmagon is about the same — about CA $325 (US $240) per month if not covered by insurance — so I wouldn't have to decide based on affordability even if I were paying for it myself.

The starting megadose of Firmagon costs a bit more (around CA $500, if I recall correctly), and I did pay for that three years ago, because my spouse's work didn't have insurance for prescription meds yet, and I wasn't enrolled in the Ontario Drug Benefit or the Trillium Drug Program (my family income that year was too high for either to help, because I'd been doing consulting work right up to the week before I was admitted to hospital).

It's interesting to hear another story of using a GnRH receptor antagonist (like Firmagon or Orgovyx) to bring down the testosterone quickly when the patient has a very high PSA, although yours was much higher than mine.

Is there any chance you could get on Pfizer's patient-access programme for Orgovyx in the U.S. (I'm not quite sure how things work down there)?