Taking Orgovyx long term

My intent is to request switching from Orgovyx to Nubeqa at 12 months. There are some recent studies using Nubeqa alone, but it's apparently not considered Standard of Care yet. Typically doctors add Nubeqa to Orgovyx (ARPI + ADT) if PSA rises while on ADT, indicating the cancer has become castrate resistant. Nubeqa (ARPI) seems to have fewer side effects, and I would like to take it in advance of any PSA rise. Testosterone will begin returning but PSA should stay low. I've met someone online with recurrent (lymph node) cancer, and he is taking Nubeqa alone with undetectable PSA and no side effects. He's being treated by Dr. Kwon at Mayo Clinic.

Thx - but I don't see myself on ADT for many years (wow 8 years for you). I think my plan with my oncologist is to see how things are at 18 months with ADT. Then if numbers look good, I will stop. Of course, with monitoring of all levels or any tests my oncologist, endocrinologist, PCP, or other providers I currently see recommend I will do.

My PSA started rising 2.5 years after salvage radiation. Hit 6.4 before I started on Lupron. No PSMA scans back then. Stayed undetectable for 2.5 years and became nmCRPC .

Mine started to rise 2.5 years after salvage radiation as well. Thanks for your response 👍

Can you take darolutamide if you've had open heart bypass surgery?

My husband has been on Orgovyx and Xtandi for a little over 2 years. He takes "vacations" from both drugs to help keep them working. He has blood draws every 6 weeks - if his PSA is over 2.0 he's on drugs, under 2.0 off drugs. It is working for him.

This sounds like it would be a complex judgement call for the patient and the medical team to make together. I understand wanting to know, but I doubt that even an oncologist or cardiologist could give a simple answer to that in an anonymous public forum.

My totally-amateur hunch is that Darolutamide would be easier on the heart than Abiraterone, since you don't have to take a steroid with it, but I could be completely wrong.

Best of luck with your treatment, whatever you choose.

Well, this is something you have to ask your doctor. I can pretty much say that it Has the fewest side effects of the four drugs that people take. So it would be the most likely drug to use.

If you’ve got an advanced case of prostate cancer, you need to be on something and Darolutamide would probably be the best for his heart, because it has the fewest side effects. That doesn’t mean it Has no side effects, Some people do have problems with it.

I want my testosterone to return while keeping my PSA low in order to have returning strength with a more normal quality of life. I won't know whether the cancer has been eliminated until I stop ADT or my PSA starts rising regardless, indicating castrate resistance and the time to begin using or adding Darolutamide. Or am I missing something?

Understandable, and that's a very personal choice. We all have to balance quality and quantity of life.

I've lost track of your situation, but if your cancer is already metastatic, taking ADT together with one of the -lutamides now is more effective than waiting to add a -lutamide later (per TITAN, etc).

If your cancer becomes castrate-resistant, you still have good treatment options these days, but they can be tougher than just taking ADT and a -lutamide, so the longer you can delay castrate resistance, the better.

Best of luck, whatever you choose.