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Adding a second medicine question
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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I don’t know. NCCN guidelines use this for prostate cancer staging as does the American Cancer Society. You can have N1 - nodal involvement but still be M0 - no distant metastasis. So while not strictly non metastatic this is no longer necessarily considered metastatic but may be considered localized or I believe termed oligometastaic and treated with curative intent.
Anyway no matter the terminology my question is does anyone have experience with the effects of stopping ADT + Nubeqa or any of the second or first generation ARSIs? A lot of ARSIs are prescribed indefinitely or until they stop working. So I was interested in any experience with dropping off the ARSIs and ADT with curative intent.
Also it’s normally ADT + Abiraterone that is used during radiation. I don’t believe there are studies completed that show that the addition of ARSI to ADT and radiation are of benefit above ADT and radiation for new patients. Or for which patients in which risk level it may be beneficial. A lot of this exists for abiraterone but not for ARSIs.
I already told you the answer to stopping ARSI drugs. There is no need to taper any of those drugs. The only thing you have to taper is prednisone if you are on Zytiga. I have done it.
Your prostate cancer should have a Pathologic Staging (pTNM): What did yours say? Something like pT2c or pT3a etc
If you are oligometastatic you ARE metastatic, as it shows in the last half of the word oligometastatic. There’s no “sort of metastatic” you either have Tumors or you don’t. If you have them, you are not non-metastatic any way you look at it. There is no such thing as localized meaning you are not metastatic.
One reason they prescribe abiraterone with ADT It’s because it reduces testosterone even more and prevents the cancer from growing. It can also shrink the metastasis. The lutamides don’t reduce testosterone, so they work quite differently.
I am T1cN1M0.
I am not asking how to get off ARSIs. I am asking if anyone with curative intent has gotten off ARSIs and what their experience has been. Have they stayed clear, has the cancer come back, did it reemerge as the same or something much worse, or are there just very few people who get off ARSIs unless they stop working, those kinds of things.
I will ask my doctors again but they have said I am not metastatic. They have not said I am oligometastatic either, that is a term they recognize but it’s something I’ve read about that sounds similar. I was mistaken if I said oligometastatic is my official diagnosis.
I know many people who have stopped their drugs after coming up undetectable for a year or so. As usual with prostate cancer, there is no standard. Some of the people went a couple years or more without Recurrence. Some people had multiple metastasis and had to have chemo or Pluvicto Along with getting back on ADT and an ARSI.
And as expected, some people had PSA rises and went back to the drugs After a few months or years.
One way to find out whether or not you have a high chance of reoccurrences to get a decipher test. There are some other tests you can also take that are similar. Speak to your doctor about this.
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Hug
1 ReactionThanks, yes my decipher was .86, will need to look at the report again as I can interpret a bit more now than when I first got it. I got ArteraAI and it said I was I unlikely to benefit from the addition of abiraterone but that was after I tried it and decipher had said abiraterone should be considered. I asked for a foundation one test, I think it is in progress.
Well, as you probably know a .86 is a high chance of recurrence.
The thing is, if Orgovyx Is working for you and keeps your PSA undetectable you could stay on just that alone. I was on it for the first 3 1/2 years after salvage radiation failed me, Then I became castrate resistant, and they added the second drug, Zytiga.
Of course, if abiraterone doesn’t work you probably Would not have a problem with Nubeqa.
Speak to your doctor see what options he’s giving you. At least you now have information after being on this forum.
Yes, thank you.
Phil