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Switching from Orgovyx to Bicalutamide

Posted by namrac @namrac, 3 days 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.

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kenk1962 | @kenk1962 | 12 hours ago
In reply to @jime51 "I'm at six months on Orgovyx and after 44 radiation treatments, with Gleason 4+3 and N1M0,..." + (show)
@jime51

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.

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Hi Jiime - do you have any insights on why Dr. Hugec's patient has a total testosterone of 1100 while using Darolutamide, an androgen receptor antagonist? A 1100 ng/dL level is quite high and suggests the patient is receiving testosterone replacement therapy (TRT).

I haven't heard of these two being used together. I'm thinking Darolutamide and TRT would likely oppose each other.

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1 reply
jime51 | @jime51 | 12 hours ago
In reply to @kenk1962 "Hi Jiime - do you have any insights on why Dr. Hugec's patient has a total..." + (show)
@kenk1962

Hi Jiime - do you have any insights on why Dr. Hugec's patient has a total testosterone of 1100 while using Darolutamide, an androgen receptor antagonist? A 1100 ng/dL level is quite high and suggests the patient is receiving testosterone replacement therapy (TRT).

I haven't heard of these two being used together. I'm thinking Darolutamide and TRT would likely oppose each other.

Jump to this post

He says he's only receiving the ARPI which allows Testosterone to rise while keeping the cancer cells from feeding on it (Androgen Receptor Pathway Inhibitor). His recurrence in three lymph nodes has disappeared, avoiding additional treatment for now.

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mmacaulay | @mmacaulay | 4 hours ago
In reply to @round5 "I’m one of Dr.Hugecs patients on darolutamide mono therapy. Too early to comment on whether it’s..." + (show)
@round5

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.

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The person you mentioned may be me. I’m 75. My urologist is Dr. Kwon of Mayo who referred me to Dr. Hujec for chemo. I was diagnosed Stage 4b metastatic Gleason 9 about 30 months ago. Started Lupron soon thereafter and added darolutamide with chemo. Subsequently did SBRT. Stopped Lupron after 13 months and am still on darolutamide mono therapy. Do PET scans every three months. My PSA is negligible. Dealing with fatigue issues. Physical therapy has helped.

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