Adding a second medicine question

Posted by pjsatz @pjsatz, Jun 21 3:36pm

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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lsk1000 | @lsk1000 | Jun 23 6:53pm

In reply to @pjsatz "Thank you, seems like one of the best combinations in many cases." + (show)

Thank you. Makes my spirits soar to hear that.

ga73ds | @ga73ds | Jun 23 9:27pm

In reply to @jeffmarc "After all this time, if your PSA has remained < .01 For over a year, stopping..." + (show)

"Close to 70% of people with PC are cured or at least go into long-term remission." I hope and pray you are correct. With Stage 4a, Gleason 9, and Decipher .99 at diagnosis its been hard for me to be positive. I've had removal + radiation + ADT (Orgovyx 29 months). Although my PSA has been < 0.01 for 25 months now post radiation, It's scary to risk coming off ADT. But, someone else on here said that maybe the "PSA trajectory" has been changed. I know I probably need to come off ADT to see what will happen, but that's scary.

boniyabes | @boniyabes | Jun 23 9:55pm

In reply to @northoftheborder "The -lutamides (Apalutamide, Enzalutamide, and Darolutamide) are newer than Abiraterone and don't require a steroid, if..." + (show)

Is the ADT you are now taking is Orgovyx?

northoftheborder | @northoftheborder | Jun 24 4:58am

In reply to @boniyabes "Is the ADT you are now taking is Orgovyx?" + (show)

Yes. Firmagon for the first 2½ years, then Orgovyx (basically Firmagon in pill form) for the past 14 months.

Orgovyx has been a real game changer compared to getting the injections — my body's much happier with a daily microdose than it was being whacked with a monthly megadose.

jeff Marchi | @jeffmarc | Jun 24 10:06am

In reply to @ga73ds ""Close to 70% of people with PC are cured or at least go into long-term remission."..." + (show)

Yes, your cancer is a high risk cancer. The thing is, you’ve gone 2 years with undetectable PSA. Can’t hurt to stop for one month to see if your PSA starts rising.

In my case, after almost a year of undetectable, I reduced my Zytiga From four pills to three to see if it would help with brain fog. In 18 days, my PSA went from .2 to 1, Back to four pills right away. I have BRCA2 Which causes real problems with prostate cancer growing from time to time. So in my case, I can’t stop the drugs without my PSA rising.

I know a lot of people with Gleason nine that have stopped taking the drugs and been able to do it for quite a long time, Over a year, Before their PSA started to rise in most cases.

lsk1000 | @lsk1000 | Jun 25 10:13am

In reply to @ga73ds ""Close to 70% of people with PC are cured or at least go into long-term remission."..." + (show)

It is very common to take a drug “holiday”. After maybe 6 months, or If and when PSA rises, vacation is over and we go back to work.

pjsatz | @pjsatz | Jul 18 3:34pm

In reply to @jeffmarc "Yonsa is another version of abiraterone. Yonsa is a micronized formulation with increase bioavailability according to..." + (show)

I did not do well on Yonsa. I took a half dose of Yonsa and methylprednisone twice daily for a few days but started to get high blood pressure, headache and unsteady, effects were similar to abiraterone but probably not quite as bad.

Am also on Orgovyx. I may start on Nubeqa. I will be on medicines for 18-24 months, am 3 1/2 months on Orgovyx and am in radiation.

I am wondering what happens when I try to get off an ARSI like Nubeqa? Nubeqa is often prescribed indefinitely. Does anyone have experience getting off of the first or second generation ARSIs while still hormone sensitive? Hoping I will still be hormone sensitive at that point and can attempt to finish treatment as doctors are aiming for curative intent. Do the blocked androgen receptors come back ultra sensitive and increase my risk in the long run?

Nubeqa is actually not approved for what I have non metastatic hormone sensitive. I am oligometastaic with localized 2 lymph nodes positive and hormone sensitive. There are no test results yet for my scenario but the doctors are willing to prescribe Nubeqa for me as I am sort of in a grey area in terms of metastatic.

Thank you,

Phil

jeff Marchi | @jeffmarc | Jul 18 4:50pm

In reply to @pjsatz "I did not do well on Yonsa. I took a half dose of Yonsa and methylprednisone..." + (show)

You can Just drop ARSI’s without any tapering. You do have to taper prednisone, however if you took abiraterone.

I’m a little puzzled, You say you have non metastatic hormone sensitive, But then, in the next sentence you say you are oligometastatic. That means you are metastatic hormone sensitive. You have up to five metastasis, That takes away the “non”

pjsatz | @pjsatz | Jul 18 6:13pm

In reply to @jeffmarc "You can Just drop ARSI’s without any tapering. You do have to taper prednisone, however if..." + (show)

My diagnosis is T1cN1M0, they consider the two lymph nodes I have to be localized. I think this is sometimes also referred to oligometastatic

A recent review of past studies, some of which is about this is entitled:

Pharmacological treatment landscape of non-metastatic hormone-sensitive prostate cancer: A narrative review on behalf of the meet-URO Group

jeff Marchi | @jeffmarc | Jul 18 7:15pm

In reply to @pjsatz "My diagnosis is T1cN1M0, they consider the two lymph nodes I have to be localized. I..." + (show)

T1cN1M0 is a staging designation used in cancer, specifically for non-small cell lung cancer and breast cancer. Not prostate cancer.

This doesn’t correlate with what you are saying about prostate cancer.

Individual Lymph nodes frequently have prostate cancer, not unusual and yes Oligometastic means that you actually have metastasis. You are metastatic, so you can get Nubeqa.

Unless you have some other type of cancer as well.