We need others' info on Stage 4 prostate cancer.

Posted by mcnobles77 @mcnobles77, 4 days ago

My husband was diagnosed with stage 4 prostate cancer with PSA 32.6 last December. Until November 2025, he did not have any symptoms and never had any PSA levels taken all his life. He's 77. Since it metastasized to his bone when it was found, he suffers from severe pain on areas affected. The first treatment recommended was ERLEADA pill once daily. He's been on it for almost a month. Level was taken at 3 weeks and his PSA went up to 38.2. I read that that is expected for some patients and will eventually come down in 3 months or so. The good thing that we observe is the pain on his shoulders have subsided to a tolerable state but the pain on his left leg affects his walking ability (Not bad as long as he is not walking).
My question is does anyone been treated with ERLEADA and how is it affecting you? We appreciate any response to this message.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for jeff Marchi @jeffmarc

@mcnobles77
Firmagon has some major drawbacks. You need to get an injection in the stomach every month. For many people, it causes pain for a few days after getting the injection. The problems get worse over time.

If a Lupron shot is given in the hip, it causes almost no problems for the majority of people. I got them Every six months for six years, Unless I pressed into the spot where I got the shot, it never bothered me.

Orgovyx is an antagonist just like Firmagon (Lupron is an agonist). Essentially, they work the same, but Orgovyx Is a pill you take once a day. Much easier than Firmagon.

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@jeffmarc
Thank you for the information. Have a great day.

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Profile picture for jeff Marchi @jeffmarc

@mcnobles77
I’ve had low RBC and low hemoglobin for about eight years, The time that I’ve been on Lupron and Orgovyx. It’s not ever been low enough to Cause anemia. Just one of the side effects of these drugs cause

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@jeffmarc
I see. Thanks.

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Profile picture for florida11 @florida11

Hi. I had metastatic PC show up on my hip around March 25. This was my 3rd reoccurrence since getting initial PC surgery in Dec. 18. About a year after surgery, I had radiation to the prostate bed and began ADT for 2 years. After I got off the ADT treatment and my PSA began to rise again, I had radiation to a lymph node and started ADT again for 18 months. I was Gleason 4+3=7 with a tertiary score of 5 (which I was told was aggressive).

My last treatment included starting Lupron and Nubeqa in April 25, then 6 chemo infusions from June to October. It's been less than 6 months since chemo, but my PSA remains undetectable.

I wish you and your family the very best of luck!

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@florida11 Thank you for sharing. We try to remain hopeful for a positive result. We pray for your complete healing and may the Lord give you and your family the faith, hope and strength during trying times.

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Profile picture for mcnobles77 @mcnobles77

@northoftheborder
That is amazing! God bless you. I will definitely mention the Firmagon to his oncologist on his next visit. So how are you doing now? Did the pain go away? My husband had severe pain due to the bone-metastasis during the first month. So far the pain has become more tolerable after treatment and with pain management ( Oxycodone and Morphine).

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@mcnobles77 I'd suggest Orgovyx over Firmagon, from personal experience. I switched when Orgovyx became widely available in Canada a couple of years ago, and have found it easier to tolerate (it's a daily pill rather than a monthly injection).

They're both GnRH antagonists, so more-or-less interchangeable in terms of suppressing testosterone (while Lupron is a GnRH agonist, which works slightly differently).

Again, best of luck!

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Profile picture for jeff Marchi @jeffmarc

@mcnobles77
Firmagon has some major drawbacks. You need to get an injection in the stomach every month. For many people, it causes pain for a few days after getting the injection. The problems get worse over time.

If a Lupron shot is given in the hip, it causes almost no problems for the majority of people. I got them Every six months for six years, Unless I pressed into the spot where I got the shot, it never bothered me.

Orgovyx is an antagonist just like Firmagon (Lupron is an agonist). Essentially, they work the same, but Orgovyx Is a pill you take once a day. Much easier than Firmagon.

Jump to this post

@jeffmarc

Hi Jeff. The Firmagon I had was delivered as subcutaneous injections by pinching the belly skin and doing the injection. Two doses of 120mg to start with, and an 80mg every 28 days. Injections themselves were nearly painless. But the injection site reaction for me was quite painful the next day and took about a week to gradually go away. I could feel welts beneath the skin where the medication was deposited. They gradually go away. The Firmagon side effect profile for me was minimal, other than loss of all sex drive. When given the chance to switch to Lupron to eliminate the number of visits to keep current, I declined and gladly continued with Firmagon. Firmagon knocked my psa from 6 down to .3 in one month.

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Profile picture for oldgreenpaint @oldgreenpaint

@jeffmarc

Hi Jeff. The Firmagon I had was delivered as subcutaneous injections by pinching the belly skin and doing the injection. Two doses of 120mg to start with, and an 80mg every 28 days. Injections themselves were nearly painless. But the injection site reaction for me was quite painful the next day and took about a week to gradually go away. I could feel welts beneath the skin where the medication was deposited. They gradually go away. The Firmagon side effect profile for me was minimal, other than loss of all sex drive. When given the chance to switch to Lupron to eliminate the number of visits to keep current, I declined and gladly continued with Firmagon. Firmagon knocked my psa from 6 down to .3 in one month.

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@oldgreenpaint
I used to get Lupron Shots every six months.

A drug that works just like Firmagon is Orgovyx, a pill you take once a day. You might find it quite preferable, going to the doctor once a month for a painful shot is not fun.

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Profile picture for jeff Marchi @jeffmarc

@oldgreenpaint
I used to get Lupron Shots every six months.

A drug that works just like Firmagon is Orgovyx, a pill you take once a day. You might find it quite preferable, going to the doctor once a month for a painful shot is not fun.

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@jeffmarc I actually pulled the plug on adt, totally, at 5 months. Half life of Firmagon is 55 days I think, so I will “be on adt”. Until about August when it should be down to about 10% still in body. Testosterone and psa are immeasurable so the stuff works. Thinking about starting a thread on that but my life is so busy now . I have what I call a weird case of PC, with one small tumor of about 1/2cc of cancer, but high risk at G8. In front part of prostate. I did radiation too, as you know, but others may be wondering. Only one marker puts me in high risk, being G8. Staging puts me at low risk, psa of 6 puts me at low risk. So I studied adt for 6-18 months as the RO initially spoke of and made my own decision to end it. I have osteoporosis, cardio vascular myself, and dementia runs in family strong. So just a calculated risk assessment led me to this decision. I think heart issues will eventually kill me, so just want the best life going forward. Doing 5 hours in Fitness Center per week to try and mitigate those issues.

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Profile picture for oldgreenpaint @oldgreenpaint

@jeffmarc I actually pulled the plug on adt, totally, at 5 months. Half life of Firmagon is 55 days I think, so I will “be on adt”. Until about August when it should be down to about 10% still in body. Testosterone and psa are immeasurable so the stuff works. Thinking about starting a thread on that but my life is so busy now . I have what I call a weird case of PC, with one small tumor of about 1/2cc of cancer, but high risk at G8. In front part of prostate. I did radiation too, as you know, but others may be wondering. Only one marker puts me in high risk, being G8. Staging puts me at low risk, psa of 6 puts me at low risk. So I studied adt for 6-18 months as the RO initially spoke of and made my own decision to end it. I have osteoporosis, cardio vascular myself, and dementia runs in family strong. So just a calculated risk assessment led me to this decision. I think heart issues will eventually kill me, so just want the best life going forward. Doing 5 hours in Fitness Center per week to try and mitigate those issues.

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@oldgreenpaint
Wish you luck with your decision. Get PSA test every three months for a couple of years, Sometimes the cancer comes back quickly. You had spread outside the prostate from what you’re saying in that can cause early reoccurrence.

You may have no problems.

If you have to go back on ADT consider using the estradiol patch. It works just as well as ADT, but it has many fewer side effects.

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