Been on Orgovyx for four months. Should I stop taking finasteride?

Posted by johnny8924 @johnny8924, Dec 22, 2024

Diagnosed with prostate cancer via a biopsy August 2024. Six cores were negative, one core Gleason 7, five cores Gleason 9. Negative for perineural invasion. Began Orgovyx August 2024, very few side effects. Original PSA was 6.0. Current PSA= 0.33, testosterone 9. Will begin beam radiation after fiducial markers in January 2025. Have been taking finasteride 1 mg daily for almost two years for suspected BPH and urinary problems. I'm considering stopping finasteride because it has the potential of producing inaccurately low PSA results, and Orgovyx appears to be successful in lowering PSA. Thanks for your comments.

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jeffMar | @jeffmarc | Dec 22, 2024

Your urinary problems won’t go away just because you have a lower PSA. This is a question you really need to ask your doctor, could stopping bring back those problems. After radiation Urinary issues won't be due to your prostate being enlarged or involved, since it will be effectively gone.

Orgovyx will leave Your PSA low enough that it won’t matter.

heavyphil | @heavyphil | Dec 23, 2024

Pretty sure finasteride will HALVE your results, so you should double whatever you have…Didn’t your RO discuss this with you Day One??
You really need to get crystal clear about how to proceed - I am just a layman like you.

johnny8924 | @johnny8924 | Dec 23, 2024

My RO implied that finasteride can produce inaccurately low PSA readings, up to 50% inaccurate. I have decided to stop taking finasteride and rely solely on Orgovyx. Thanks for your comments.

johnny8924 | @johnny8924 | Dec 29, 2024

Is there some causal and/or correlative relationship between finasteride and high grade prostate cancer?

heavyphil | @heavyphil | Dec 30, 2024

In reply to @johnny8924 "Is there some causal and/or correlative relationship between finasteride and high grade prostate cancer?" + (show)

Yes, johnny, there is a relationship, but to date there really is no clear smoking gun.
Your urinary problems ‘should’ resolve with your successful cancer treatment, but if not you really have to sit down with your doctor and discuss what options there are for better urination.
There are minor procedures- such as fulguration - which widen the opening where the bladder meets the urethra. I had this done and got instant relief.

theskeptic | @theskeptic | Feb 2 9:10am

In reply to @heavyphil "Pretty sure finasteride will HALVE your results, so you should double whatever you have…Didn’t your RO..." + (show)

You are correct. I found this out when I went to Duke University Cancer Clinic.
Im disappointed that my regular local urologist never mentioned this or wasn't too concerned. Honestly I do not think he knew OR forgot to check my meds, even though he prescribed Finasteride. I asked for biopsy two times. He asked me to wait 6 months, since I have 3 previous ones with the last one in 2021 (in a different medical practice)

So after waiting 6 months and my PSA kept getting higher, I reminded him that we were to talk about a biopsy. He gave me a choice of waiting another 6 months or doing one. I said DO ONE!
Cancer turned up, I went to Duke for an evaluation and they were VERY concerned that my PSA was 11.5 because they told me it has to be doubled to 23 being I was on Finasteride

The key here is do not play doctor but ask questions. So even now I am getting conflicting answers from two medical oncologists if I should stop taking it or not, the second one was ok with stopping it after I told him about the other. I decided to stop taking it being I have been on Orgovyx for a few weeks now, concerned that some doctor might mis interpret my PSA because of the Finasteride. I start radiation in two weeks. Good luck to all of you, be proactive, ask questions and get second opinions

theskeptic | @theskeptic | Feb 2 9:15am

In reply to @johnny8924 "My RO implied that finasteride can produce inaccurately low PSA readings, up to 50% inaccurate. I..." + (show)

Yes, agree. I have done the same, it's REALLY frustrating. You do need to double your PSA score with Finasteride. I feel like we are in the dark ages and it's quite scary that some doctors do not know this or check to see if you are on it?

So I stopped and I do find myself getting up more ofter during the night again. But I am afraid of my PSA being mis read AND afraid that no matter what doctor I ask I get conflicting answers or "fluff' about taking Finasteride

Ill try one more doctor on one week and talk to my radiation oncologist.

johnny8924 | @johnny8924 | Feb 3 10:20am

My radiation oncologist said to stop taking finasteride. Urologist said it doesn't matter either way. I decided to stop taking it weeks ago.

garylr | @garylr | Feb 3 10:44am

In reply to @heavyphil "Yes, johnny, there is a relationship, but to date there really is no clear smoking gun...." + (show)

There seems to be a relationship, but it's not entirely clear whether it's positive or negative:
https://www.cancer.gov/news-events/cancer-currents-blog/2019/prostate-cancer-prevention-finasteride-parnes
It doesn't seem like there's any need to get worked up about this, but I absolutely agree that Johnny should talk this over with his docs.

heavyphil | @heavyphil | Feb 3 11:47am

In reply to @garylr "There seems to be a relationship, but it's not entirely clear whether it's positive or negative:..." + (show)

Yup, clear as mud. However, my friend had SBRT at Sloan last year and had trouble urinating.
His RO prescribed Finasteride and it did the trick; but she pulled him off it immediately once treatment was completed.
She said that there was a feeling that it could induce more cancer even though there was no clear cut evidence.
The article you cited was from 2019 so maybe there’s been more research on it since then. But I haven’t seen anything published more recently.