Switching from Orgovyx to Bicalutamide

Posted by namrac @namrac, 12 hours ago

Hi everyone,
I’m looking for insight or personal experiences with Bicalutamide as a follow-up or alternative to Orgovyx.
I’ve been on Orgovyx (relugolix) for about 14 months, starting it approximately 3 weeks before radiation. I was diagnosed with Gleason 4+3 and stage 4a prostate cancer (due to local spread). I’ve had a great response so far – my PSA is currently < 0.01, and I’m scheduled to stay on ADT for 18 months total.
The problem is, I’m experiencing severe side effects from Orgovyx – practically every known one – and my quality of life has really taken a hit.
My radiation oncologist suggested switching to Bicalutamide, even though it's an older drug. He says he’s had good results with it. I’m a bit hesitant, mainly because:
1. Bicalutamide doesn’t lower testosterone like Orgovyx – is it enough for someone with high-risk or stage 4a disease?
2. I’ve read that Bicalutamide can cause liver toxicity. Has anyone experienced this?
3. Would switching at this point (14 months in) reduce cancer control effectiveness, or could it serve as a “bridge” for the final few months?
Has anyone here:
• Switched from Orgovyx to Bicalutamide?
• Used Bicalutamide as monotherapy or in combination?
• Had liver or other significant side effects?
Would really appreciate hearing about your experience or what your doctors have advised.

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

jeff Marchi | @jeffmarc | 11 hours ago

When Lupron failed me after 2 1/2 years and I became castrate resistant I went on Biclutamide in addition to Lupron. My PSA went down from .3 to .2 for three months, but then it started rising and 14 months later was at 1.2 so I went on abiraterone. In my case, I stayed on Lupron because not all of the prostate cancer has become castrate resistant just some of it, so Lupron can help still. Abiraterone Was able to keep my PSA manageable for about 2 1/2 years but caused too many heart issues.

I switched to Darolutamide And it has been working really well. I’ve been undetectable for 19 months, And after all those drugs and 15 years of treatment, that product works well.

I know a number of people who are on Darolutamide standalone And it works well, even though there is testosterone there. You might ask your doctor if it was possible to get that drug. It has the least side effects of all the lutamides. Never had problems with liver tests that I get a every month.

Staying with Orgovyx for the recommended period may give you better results. You are four months away, It may be worth hanging in there.