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!