Adding a second medicine question

Posted by pjsatz @pjsatz, 2 days ago

I am told by doctors they would like to add second medicine to Orgovyx which I have been doing ok on for about 2 1/2 months. They say I could stay on Orgovyx only but there is possible benefit to adding a second one. I did not do well on abiraterone and prednisone, had bad headaches. If approved I could try Yonsa with a different type of steroid. I could try one of the androgen receptor inhibitors. Is it worth taking an androgen receptor blocker when my testosterone is around 10 ng/d and psa has dropped a lot?

A second drug could possibly help with delaying disease resistance. But it can also encourage some types of resistance. I don’t know that there is a definite answer here but just looking for any ideas or experiences in a case like this.

Thanks,

Phil

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@mjp0512

FWIW, I was started on Orgovyx based on biopsy results (Geason 9 - 5+4) and it was started immediately following a PSMA PET scan. Nubequa was added immediately after the PET results showed metastatic lymph and bone involvement 4 days later. I'm new at this fight and just a layman, but I would think that unless testosterone is a confirmed zero, ARI added to ADT is prudent, especially if the disease has spread beyond the prostate.

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Thank you, thanks for the help. Are they adding radiation for you? Wish you all the best with this.

Phil

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@pjsatz

I had Gleason 8 on 2 of 12 biopsy samples characterized high risk, 1 Gleason 7, 1 Gleason 6, and 2 pelvic lymph nodes positive on PSMA PET scan. Am characterized as T1N1M0. I have been on Orgovyx since March 30th and briefly had abiraterone, my psa dropped from 30 on March 25th to .46 on June 5th. Will get radiation starting mid July.

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You are a Gleason 8. The doctors do not really consider the other lower numbers.

The reason they want the second drug is that your PSA should have been able to be dropped to below .2 by now. So the second drug can push it a little further down. As I mentioned, ask your Doctor about Darolutamide. I can lower your PSA even further and has very few side effects. I’ve been using it a long time and I know a lot of other people using it. If you can’t handle abiraterone Then that is a great second choice.

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My 2 Gleason 8 are 4+4. On one which measured 9 mm they identified cribiform pattern 4, perineural invasion, and lymphovascular space invasion. My decipher score was .86.

Thanks,

Phil

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@pjsatz

Thank you, thanks for the help. Are they adding radiation for you? Wish you all the best with this.

Phil

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Well, I was referred to radiation oncology but I'm still waiting for a call from scheduling. We shall see. Thanks for the good wishes and the best possible outcome to you as well.

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@jeffmarc

You are a Gleason 8. The doctors do not really consider the other lower numbers.

The reason they want the second drug is that your PSA should have been able to be dropped to below .2 by now. So the second drug can push it a little further down. As I mentioned, ask your Doctor about Darolutamide. I can lower your PSA even further and has very few side effects. I’ve been using it a long time and I know a lot of other people using it. If you can’t handle abiraterone Then that is a great second choice.

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Thanks. They did want to prescribe a second drug at the beginning, Due to high risk, I guess. I will have my psa checked again this week. My oncologist mentioned will likely recommend enzalutamide. Am going to meet with him again this week. A second opinion doctor recommended trying Yonsa, and if that doesn’t work darolutamide.

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Yonsa is another version of abiraterone. Yonsa is a micronized formulation with increase bioavailability according to Sun, pharmaceuticals. You can take with or without food and you also take half the dosage of regular Zytiga 500mg. It even uses a different type of steroid methylprednisolone,

Should be interesting to hear the results after taking that drug. please come back and let us know.

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@jeffmarc

Yonsa is another version of abiraterone. Yonsa is a micronized formulation with increase bioavailability according to Sun, pharmaceuticals. You can take with or without food and you also take half the dosage of regular Zytiga 500mg. It even uses a different type of steroid methylprednisolone,

Should be interesting to hear the results after taking that drug. please come back and let us know.

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Will let you know what happens if I end up trying it. I have heard some people have less side effects on Yonsa than abiraterone but my doctor doesn’t think it will make a difference so need to see if he is even willing to have me try it.

Thanks,

Phil

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My medical oncologist recently told me the standard care today is to use 2 drug combinations for max efficacy. His first thought was Nubeqa + Orgovyx.

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@lsk1000

My medical oncologist recently told me the standard care today is to use 2 drug combinations for max efficacy. His first thought was Nubeqa + Orgovyx.

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Thank you, seems like one of the best combinations in many cases.

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@pjsatz

Thank you, seems like one of the best combinations in many cases.

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There have been quite a number of doublet therapy clinical trials (even more than on just this chart) for various stages of prostate cancer.

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