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The treatment begins. I hope it makes sense.

Posted by stew80 @stew80, Feb 27 3:38pm

After 'clean' scans and a biopsy showing Gleason 9 with cribriform and PNI, the Urologist's office (nurse practitioner) called to say they want to start me right away on Casodex for 30 days, and prescribed an Eligard injection (to be given in 10 days). That coupled with an appointment in June with a radiation/Oncologist. That's all I know until I have my formal meeting with my Urologist to review all the results and I guess a recommended treatment plan. Does this sound like a typical beginning?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

heavyphil | @heavyphil | Mar 1 1:16pm
In reply to @jeffmarc "Funny how drug pricing is so different. In 2024 Kaiser decided to start charging for infusions...." + (show)
@jeffmarc

Funny how drug pricing is so different. In 2024 Kaiser decided to start charging for infusions. As a result, my six month Lupron shot now cost $400 every six months, Instead of $0.

On the other hand, Orgovyx Cost me nothing for the year. The first time I order a refill for Darolutamide I hit the Medicare maximum,

A little info on how Medicare paid/pays for prescription drugs
Last year I paid $3,237 refilling Darolutamide, once I spent another $100 on drugs the Medicare $8000 maximum for drugs was hit (Costs include what provider pays). everything that requires a prescription was free from the pharmacy for the rest of 2024. This year I paid $2000 for my first refill of Darolutamide, everything that requires a prescription is free from the pharmacy for the rest of 2025. Nice change to Medicare regulations, hopefully this doesn’t get changed again and changed back to 2024 regulations

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Yes, that new $2,000 max cap is a godsend for a lot of people on some very expensive drugs

REPLY
kujhawk1978 | @kujhawk1978 | Mar 2 10:38am

It does make sense, question is, is it the best treatment...?

As others have said, discuss with your medical team using Orgovyx vice what they are saying.

The advantages are generally well understood:
Lowe CV side effect profile
No flare
Faster to castration levels (< 20)
Higher sustained castration while on it.
Faster recovery of T,

Potential disadvantages:
Financial toxicity depending on one's insurance
Must take daily

Recovery of T (rate and amount) is not a given, factors include Baseline T, Age, Lengthy of Time on ADT and possibly how active you are (exercise) after coming off T.

Given your high-risk category, may want to discuss with your medical team if, when, to add an ARI - doublet therapy. Not sure triplet therapy is on the table given the age.

June for an appointment with a radiologist and oncologist, hmm, surely they can do better than that!

As to the PSMA scan, question is, will a positive outcome, i.e. locating PCa outside the prostate in lymph nodes, bones or organs, change the treatment decision? If yes, then ok, do it. However, going on ADT now and then having a PSMA scan seems backwards to this layman. Locating PCa outside the prostate can change the treatment decision, the radiologist has something to target with boosts and wider margins, the oncologist may consider PARP Inhibitors, Radio Isotopes...your medical team may want to order genetic testing to aid in treatment decision making.

You ask, does this make sense, yes, my take is it's a minimalist approach and given the clinical data you describe, your urologist may not be aggressive enough in the treatment plan nor in bringing other medicals specialists into the treatment decision - radiologist, oncologist, to gather sufficient clinical data to build the best treatment plan.

Kevin
REPLY
stew80 | @stew80 | Mar 2 3:43pm

Wow. Thank you for sharing this. Lots to think about. I've taken notes and will be meeting with the Urologist (who is my quarterback) on 3/10.

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