Castration Resistance

I suggest you follow this thread. I just started reading it, I'm sure you'll get good answers. I myself will read the rest of the replies. I'm
I'm my 10th week in Orgovyx and if at all possible, subject to professional advice, I wish to go on holiday after six months. Do intermittent?

I became castrate resistance 2 years after starting Lupron. That was almost 6 years ago. As your doctor said, the results may vary, It could take longer time or less time there’s no way to know.

Quick history

In 2010 I was 62 and a biopsy showed Gleason 3+4. Had surgery, after surgery they told me it was a 4+3. It was only stage two. 3.5 Years later it came back and I had radiation. 2 1/2 years later it came back and I went on Lupron. I became castrate resistant 2. years later and added biclautamide. 1 year later went on Zytiga, which kept my PSA down for 2 1/2 years., After some AFIB Issues I switched over to Nubeqa, The last 18 months I’ve been undetectable. I became stage four about six years ago. I did not find out I was BRCA2 Until four years ago.

In 2021, they initially told me 18-24 months to castrate resistance.

However. the TITAN trial had just shown that for mCSPC. adding a -lutamide to ADT (Apalutamide in their case) ab-initio instead of waiting for castrate resistance significantly extends the no-progression time.

Fortunately. my RO knew about that study when I was diagnosed in 2021, and it's still working to keep my cancer castrate-sensitive in 2025 (along with a "curative" dose of SBRT to the prostate, and debulking surgery and post-op SBRT to my spine).

As @jeffmarc wrote. your mileage may vary.

I am on month 8 of Trelstar, + Nubeqa. PSA is undetectable for now. My urologist and oncologist tell me it could be up to a decade before it becomes castration resistant, and I have the BRCA 2 gene mutation. However, they don’t really know, that’s why they use the word “could”.

I think you're in good shape! Nubeqa is to stop the process by which cancer cells become castrate-resistant, which would typically be around 18-20 months of treatment. As cowboys used to say, "You're cutting them off at the pass." Congratulations on a comprehensive treatment plan! How are the side effects? I'm just on Orgovyx, but until I was about 5 weeks past radiation, I was really beaten down most of the time. Some energy is slowly returning.

Hi @jeffmarc ,
For high risk PCa, If you have to do salvage/adjuvent radiation, is it better to go on ADT before radiation for a couple years or better to wait to see if you have a BCR after radiation?

My radiation oncologist doesn't like intermittent unless there's no reasonable expectation for a cure. I'm in my sixth month of Orgovyx and instead of their recommendation of 24 months (Gleason 7, N1M0), I want to jump ship at 12 months to switch to Nubeqa for 6-12 months, in order to discourage castrate resistance. I completed 44 weekday radiation treatments in April. Test in May showed Testosterone 0, PSA 0.01.

On ADT for 2 1/2 years when PSA started climbing. Bone metastasis now. On Xtandi and Xgeva for 4 months. Continuing with Lupron also. The Xtandi does not seem to be effective. Back to Dr in August, if still no good response will start 1st level chemotherapy. Very disappointing to be in this fight again after 16 years out from prostatectomy and radiation. Three biopsies and a surgical removal of major prostate tissue before another test found the big C back then. Dreading the next type of treatment of chemotherapy.

I stage 4 denovo and I am thankfully still castrate/hormone sensitive at 3 years.

Thank you for sharing. I wish you the very best of luck!