Switching from Orgovyx to Bicalutamide

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.

I'm at six months on Orgovyx and after 44 radiation treatments, with Gleason 4+3 and N1M0, iliac lymph nodes and latest PSA 0.01, testosterone 0. I'm campaigning with my oncologist to switch to a similar drug, Darolutamide, after one year. I've met a gentleman online who has used Darolutamide alone since August. Latest Testosterone 1100, PSA undetectable, former lymph node activity also undetectable. His Dr. Hugec in Minnesota has reportedly 20 patients on this monotherapy. I too have experienced every Orgovyx side effect with fatigue being the major daily issue. Exercise helps some: I had an unrelated surgery recently and without daily exercise, fatigue has been really slamming me. Darolutamide/Nubeqa seems to have lesser influence on fatigue, brain fog, and heart issues. By switching, I'm hoping to lessen side effects and prevent the cancer becoming castrate resistant.

Hi Jeff, glad you’re doing well. I just started taking Abiraterone in conjunction with Orgovyx, I was curious as to what heart related side effects you experienced or was concerning enough to stop the abiraterone? Also are you exclusively on Darolutamide? Thank you.

I’m one of Dr.Hugecs patients on darolutamide mono therapy. Too early to comment on whether it’s working because I just stopped my Lupron a few months ago and testosterone is still below 20. I would like to communicate with the person you met who has been on it since August? I’ve not been able to find anyone yet but Dr.Hugec did tell me he had others doing it.

I reached out to him and invited him to respond.

I’ve never seen anyone on these forums mention of replacing Orgovyx with Casodex.

Bicalutimude (Casodex) is typically used for a specific purpose . Bicalutimide is given for a short period of time prior to starting LHRH-agonist hormone therapies (like Eligard, Lupron, etc.), in order to prevent testosterone (tumor) flare (https://www.oncolink.org/cancers/prostate/treatments/tumor-flare-in-prostate-cancer).

In English —> After starting hormone therapy, the body realizes testosterone (T) are slowly dropping, and tells the body to produce more T to offset the slow drop. This may cause a brief “spike” in T which can result in what is called "tumor flare” or “testosterone flare.” - not a good thing to happen since prostate cancer feeds on T.

This temporary flare can be managed by first taking Bicalutimide which blocks T from attaching to prostate cancer cells, which reduces the risk of tumor flare when hormone therapy is started. Tumor flare does not last long and will go away as the T level goes further down after a hormone injection.

On the other hand, when starting with Relugolix (Orgovyx) or Firmagon, T levels drop so quickly that the body doesn’t have time to realize that T levels are dropping, thus the “testosterone flare” effect doesn’t occur.

I have often read of replacing Orgovyx (once T & PSA levels are already suppressed) with one of the 1st generation hormone therapies (like: Lupron, Eligard, etc.).

As for the ADT side-effects, most experience similar ones with Lupron, Eligard, etc. as they did with Orgovyx.

> Did your doctors recommend resistance training exercise prior to starting ADT in order to minimize the side-effects? (https://m.youtube.com/watch?v=YE61HSAsFb0)

(I started on Bicalutimide prior to Eligard and proton radiation for my localized 4+3=7. ADT side-effects were minimized due to the resistance-training regimen advised by my medical oncologist. Now four years later, my PSA varies between 0.35-0.55; most recent PSA ten days ago was 0.473.)

Good luck!

Abiraterone caused me to have four afib events. The third one put me in the hospital for four days with a very high pulse. After stopping abiraterone I still had one more afib Event a few months later. Since then, I have done what caused the afib event over and over without any problems at all.

Abiraterone Also raised my blood pressure from normal to high. I have to take three different drugs every day to keep my blood pressure low. I still have to take them even though I quit abiraterone Two years ago.

Biclutamide is definitely a drug that can be used in different ways.

A guy I know has gone off and on Biclutamide for over five years. Every time his PSA would rise, he would start back on it, And when it got to undetectable, he would stop it. He eventually had to go to a second drug, but he got a lot of use out of Biclutamide.

I tried to convince him to go on a real ADT drug, But the side effects were Something he would say made them undesirable.

I realized I didn’t answer all of your questions.

I did stop Orgovyx For eight months and was on Darolutamide Alone for that time. My PSA stayed undetectable the whole time.

The problem is that even after eight years on ADT my Testosterone started coming back quickly. Because I am BRCA2 My oncologist thought it would be best that I start back on Orgovyx when my testosterone went over 50.

Over at the advanced prostate cancer weekly meeting of Ancan.org. You will find that there are a number of people that are on Darolutamide alone. It is very effective with people that are not on ADT to suppress their testosterone.

I have posted here a few times now about my experience with Orgovyx but I am posting it again because I really believe it works, well, for me anyway. I had prostatectomy in 2014. Radiation after 3 months, PSA is .04, radiation after 3 years when PSA was greater than .2, and started Orgovyx in Oct 2024 when PSA was 5.5. After 3 weeks on Orgovyx, PSA was .8 and after another 4 weeks, PSA was .2. Last April (2025), my PSA was .1 so I suggested to my Hematologist that I will start taking Orgovyx every other day but he did not propose. I started taking it every other day anyway and I will have labs next month to see what is the result of my being stubborn (?). My suggestion to you is have ADT vacation since your PSA is very low (almost undetectable). I know those side effects because all had/have them, too, but I did tolerate them, I do my daily morning stretch outs, and walk for about 20 minutes thereafter. It helps relieve the pain on my legs and make me feel stronger. Stay strong and try to help more of yourself. You will get better.