Jeffmarc/ north of the border are most qualified to give you advise. FYI

I used orgovyx. It was the RO's drug of choice. The conventional wisdom seems to be a) it's more even as you suggest since you take it every day. b) It's not a shot, so less painful and c) the belief is that you recover from the side effects more quickly. I really don't know about the 3rd one.

I would've have thought the thing to do, depending on other medical history, would be ADT for a few months then a targeted radiation to that tumor. (others likely will have more info)

I think getting a straight answer is tough because there are a lot of other variables, such as insurance coverage. If I recall the Orgovyx was about $80 per pill in the US, I was lucky and it was all covered but not everyone is in that situation. Maybe Lupron is covered and Orgovyx isn't etc.. Without getting too far up on my soapbox, unfortunately, a lot of docs here in the US seem to answer questions based on things like that instead of what is medically best for us.

There also may be something in your medical history that makes one better than the other.
Best of Luck to you!

Hi 13Roadrunner,
I was on lupron + abiraterone and prednisone for 24 months and had proton therapy for gleason 9 with cribform. My PCP had me start rosuvastatin upon diagnosis to help prevent CV issues from treatment. My experience with ADT at age 68 wasn't all that bad. I had all of the symptoms you read about, but did a minimum of 30 minutes of vigorous aerobic exercise and 30 minutes of resistance training 3 times a week and followed a largely plant based diet including 1g of protien/kg of body weight. I was able to continue to work part time, mountain bike, hike, kayak and xc ski with friends, although I was not as fast/strong as I was before treatment or as fast/strong as I am now a year after treatment.

Regarding the 3 month lupron shot in the hip, it wasn't painful and the cost was covered by Medicare. I understand that there is potentially a short term surge if T prior it dropping which doesn't happen with orgovyx. Following treatment, T recovery is evidently much faster from orgovyx. Orgovyx, on many medicare supplement plans, will cost you the full $2,000 Part D copay each year. From reading about orgovyx side-effects, it sounds like they are very similar to lupron, but might have lower cardiovascular risk. If my recurrance happened today, I would probably go with the orgovyx because it drops the testosterone faster, has a lower risk of cardiovascular side effects and T levels return to normal more quickly. However, I'm not thrilled about the price, having to decide to take the pill that is causing the side effects each day and I wonder if the devil I know might be better than the devil I don't know...

I wish you luck on a your decision. In your case, I'm not sure that either one is the wrong choice.
Bill