Is PSA rise inevitable after hormone therapy?

Posted by rwski79 @rwski79, Mar 18 9:31am

In 2024 I had a prostatectomy & PSA rose, am a Gleason 9, stage 4. PSMA detected lung nodules (only area) that disappeared after Eligard injection and PSA became undetectable. Added Nubeqa for “doublet” therapy. Given the above, has anyone had PSA remain undetectable for a long period ? How long? Or is it inevitable PSA will rise with just doublet therapy? Is adding Chemo (Docetaxel?) INEVITABLE to keep PSA undetectable for longer? Have foot neuropathy so hesitate with chemo that risks more advanced, permanent neuropathy. So far hot flashes(big time!)only side effect from hormone therapy.

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

@graybeard46

I need to decide in 3 weeks to get my Lupron shot despite surgery and radiation. I have forgotten comments in the past that there may be a better substitute for Lupron ? If so please remind me , not sure why my oncologist didn’t discuss other options, they seem to be sold on Lupron?

Jump to this post

Orgovyx is pills rather than an injection. The main chronic side effects are the same (low testosterone is low testosterone), but the acute side-effects that I had after every Firmagon injection aren't there (swelling at the injection site, a fews days of flu-like symptoms, etc) and your testosterone recovers faster when you stop.

REPLY
@graybeard46

I need to decide in 3 weeks to get my Lupron shot despite surgery and radiation. I have forgotten comments in the past that there may be a better substitute for Lupron ? If so please remind me , not sure why my oncologist didn’t discuss other options, they seem to be sold on Lupron?

Jump to this post

The estradiol patch or gel has been found to be just as effective as ADT in reducing testosterone. Estradiol has fewer side effects, Less bone loss, and reduced hot flashes.

Look up the Patch Trial for more info.

REPLY
@graybeard46

This will be my second lupron shot , first one was before I went through the radiation, guess I throw the dice , despite my oncologist is not a warm and friendly guy , he is regarded as one of the best in Boston 🤷‍♂️🤷‍♂️🤷‍♂️

Jump to this post

Orgovyx is oral. Same ADT effect but hopefully less side effects; faster recovery is well documented.

REPLY
@heavyphil

Orgovyx is oral. Same ADT effect but hopefully less side effects; faster recovery is well documented.

Jump to this post

There's really little reason for most people to still be going through the discomfort of ADT injections any more, except that some insurers don't want to pay the extra $$$ for Orgovyx

(Exceptions: prostate-cancer patients with dementia or other cognitive disorders, where it might be beneficial for the doctor to give the injection to make sure the patient is getting their ADT, and the small number of patients who don't respond to GnRH receptor antagonists.)

REPLY
@heavyphil

Orgovyx is oral. Same ADT effect but hopefully less side effects; faster recovery is well documented.

Jump to this post

So I have a question: I watched a video produced by Dr. Eugene Kwon at the Prostate Cancer Research Institute discussing hardening of resistance by long-term use of suppressive forms of therapy. "We strongly prefer taxane-based chemotherapy for initial treatment after a patient has failed both hormone therapy and an ARPI agent." Thoughts?

REPLY
@nparadisum

So I have a question: I watched a video produced by Dr. Eugene Kwon at the Prostate Cancer Research Institute discussing hardening of resistance by long-term use of suppressive forms of therapy. "We strongly prefer taxane-based chemotherapy for initial treatment after a patient has failed both hormone therapy and an ARPI agent." Thoughts?

Jump to this post

Sorry, that’s a question way above my scope of knowledge. @jeffmarc or @northoftheborder or @stevecando will probably know.

REPLY
@heavyphil

Sorry, that’s a question way above my scope of knowledge. @jeffmarc or @northoftheborder or @stevecando will probably know.

Jump to this post

Hormone therapy and ARSI are still working for me. I don't know for sure what we'll do if/when they "fail" (which is what Dr Kwon is discussing, according to @nparadisum).

I'd think chemo and/or Pluvicto might end up being good options, or maybe trying a different -lutamide. Or maybe I'll never get there, or at least won't until there are new treatment alternatives.

Also, if there are only a couple of hotspots on a PSMA PET scan, we might be able to radiate them directly and reset the clock, so to speak.

REPLY
@northoftheborder

Hormone therapy and ARSI are still working for me. I don't know for sure what we'll do if/when they "fail" (which is what Dr Kwon is discussing, according to @nparadisum).

I'd think chemo and/or Pluvicto might end up being good options, or maybe trying a different -lutamide. Or maybe I'll never get there, or at least won't until there are new treatment alternatives.

Also, if there are only a couple of hotspots on a PSMA PET scan, we might be able to radiate them directly and reset the clock, so to speak.

Jump to this post

A quick Google and the answer is Docetaxel, which is already extensively used in triplet therapy or alone after ADT failure.
Many on the forum have used this drug and reported success; also, the fearsome side effects of “chemo” seemed to be felt to a lesser degree by most patients.
Having not gotten to that stage myself ( hopefully NEVER🤞) I was not familiar with the taxane family of drugs, sorry…

REPLY
@heavyphil

A quick Google and the answer is Docetaxel, which is already extensively used in triplet therapy or alone after ADT failure.
Many on the forum have used this drug and reported success; also, the fearsome side effects of “chemo” seemed to be felt to a lesser degree by most patients.
Having not gotten to that stage myself ( hopefully NEVER🤞) I was not familiar with the taxane family of drugs, sorry…

Jump to this post

Yes, the triplet of chemotherapy + ARSI (like one of the -lutamides) + ADT (like Orgovyx) seems to be the cutting-edge standard of care for polymetastatic prostate cancer these days.

For oligometastatic, spot radiation to the individual metastases seems to be preferred over chemo, but I'm sure there are many exceptions.

REPLY
@northoftheborder

There's really little reason for most people to still be going through the discomfort of ADT injections any more, except that some insurers don't want to pay the extra $$$ for Orgovyx

(Exceptions: prostate-cancer patients with dementia or other cognitive disorders, where it might be beneficial for the doctor to give the injection to make sure the patient is getting their ADT, and the small number of patients who don't respond to GnRH receptor antagonists.)

Jump to this post

I was going to change from Lupron to Orgorvyx but haven't had anything higher than a warm flash with zero sweats. My concern is Orgovys will trigger them. Rethinking changing. With high-risk cancer I might benefit from a slower ADT recovery.

REPLY
Please sign in or register to post a reply.