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ADT injection: Benefits worth the toll it will take on my body?

Posted by imnru @imnru, Jan 13 5:13pm

I’m 62 and will start Proton Therapy next week. My psa is 8, with a 3+4 Gleason 7. my doctor is suggestion ADT for 6months. I’m concern with the muscle loss and other adverse affects. Is the 

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northoftheborder | @northoftheborder | 6 days ago
In reply to @dantewedge "I'm 59 and diagnosed with stage 2 w/ 3+4 gleason score. They are recommending an Eligard..." + (show)
Profile picture for dantewedge @dantewedge

I'm 59 and diagnosed with stage 2 w/ 3+4 gleason score. They are recommending an Eligard shot tomorrow and then SBRT treatment in about 3 months along with a second shot (3 months each)

My question is: is firmagon a better option? Seems to get better reviews? My oncologist is saying this is likely just a 6month plan with 2 Eligard shots...one tomorrow and then one right before the SBRT treatment. When I asked about the other treatments, he said he was open to doing that. My question is, Is one drug preferred over the other? I'm already overweight. Just lost 30 pounds in the last year but got another 35 to go. lol. Beyond that, the side effects seem less daunting with Firmagon. Any thoughts would be appreciated, as I go in tomorrow to either get a shot or postpone.

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@dantewedge Many patients prefer Orgovyx (daily pills) to either of the shots, if your insurance will cover it.

Like Firmagon, Orgovyx is a GnRH antagonist, so it will start suppressing your testosterone immediately instead of causing an initial surge like Eligard does. But they all get the job done in the end.

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deccakid | @deccakid | 6 days ago
In reply to @colleenyoung "@deccakid, what did you find out at your appointment? Next steps?" + (show)
Profile picture for Colleen Young, Connect Director @colleenyoung

@deccakid, what did you find out at your appointment? Next steps?

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@colleenyoung
Hi...I fogot I'd written that ("Chemo Brain")...LOL
Yes, as the PSA's continued to rise (with a low testosterone='castration resistant), I did commence with the Pluvicto treatments. I've had one treatment so far and the "only" side effect, aside from 3-5 days of complete isolation, is extreme tiredness...and I mean EXTREME!!...
...but, 'sorry if this sounds crass, but I'd rather be tired than dead. I can still do my daily duties...just not so many and longer to do them, but it's not really been too much of a hindrance....The next steps are to continue with the Pluvicto, monitor PSA and perhaps do a PSMA-PET scan after 4 treatments to see if need to do more...
Blessings

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odie10 | @odie10 | 6 days ago

I've done Eligard and Nubeqa for a year, so far, and the muscle loss is significant. It leaves me hurting when I do simple things like getting up out of a chair. I work out, but believe I'm still losing muscle.

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Jeff Marchi | @jeffmarc | 6 days ago
In reply to @dantewedge "Newbie here! Thanks for all the great information in this thread. I'm 59 yrs old an..." + (show)
Profile picture for dantewedge @dantewedge

Newbie here!

Thanks for all the great information in this thread.
I'm 59 yrs old an just started the "journey". PSA's of 4.38,5.58 and 5.03 in oct, dec 2025 and Feb of 2026, respectively.

Had MRI, then biopsy, then psma Pet Scan to determine stage 2 with a gleason 3+4. Unfortunatley they found a 3 cm mass in my kidney at the same time. So, biopsy, another MRI and then a final stain test right before i was scheduled for partial nephrectomy......and the last test confirmed bengin tumor in the kidney. So....back to the prostate cancer.

I've settled on the SBRT treatment in about 3 months after they give me hormone injection.

My QUESTION for the group is: Is Eligard or Firmagon the better option? My reading says Firmagon but I'm scheduled for Eligard injection tomorrow......ANY advice would be appreciated. Good luck to all of you!!!

Thank you, Daniel

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@dantewedge
Firmagon is a problem. You have to get it injected into your stomach every month. After a while it causes a lot of problems for most people. Orgovyx is A pill you take once a day and is similar to firmagon. It is a lot more preferable. Both of them are antagonists. Lupron and Eligard are both agonists, using luprolide.

Talk to your doctor about this. There’s no reason you have to take Firmagon And get Monthly stomach injections. Orgovyx Has fewer side effects than Eligard say most people on it, Your testosterone comes back quicker when you stop taking it and it has a lower chance of arteriosclerosis Building up in your arteries.

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chippydoo | @chippydoo | 6 days ago
In reply to @dantewedge "Newbie here! Thanks for all the great information in this thread. I'm 59 yrs old an..." + (show)
Profile picture for dantewedge @dantewedge

Newbie here!

Thanks for all the great information in this thread.
I'm 59 yrs old an just started the "journey". PSA's of 4.38,5.58 and 5.03 in oct, dec 2025 and Feb of 2026, respectively.

Had MRI, then biopsy, then psma Pet Scan to determine stage 2 with a gleason 3+4. Unfortunatley they found a 3 cm mass in my kidney at the same time. So, biopsy, another MRI and then a final stain test right before i was scheduled for partial nephrectomy......and the last test confirmed bengin tumor in the kidney. So....back to the prostate cancer.

I've settled on the SBRT treatment in about 3 months after they give me hormone injection.

My QUESTION for the group is: Is Eligard or Firmagon the better option? My reading says Firmagon but I'm scheduled for Eligard injection tomorrow......ANY advice would be appreciated. Good luck to all of you!!!

Thank you, Daniel

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@dantewedge Orgovyx if you can get it. I did 3 months of Lupron and went anemic. I had my primary do a blood panel prior to starting treatment to look at lipids and hemoglobin. At 3 months lipids were good and hemo dropped to anemic levels and the huffing and puffing during anything strenuous started. Switched to Orgovyx and the anemia corrected but LDL started rising. Self-advocacy is extremely important during these treatments. Don't be an old man that sits there and just takes what is given to you. Our niece is the GM of a residential retirement community and stated that is a big problem among seniors. Stay informed, ask questions even if they don't want to hear them.

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guybe | @guybe | 5 days ago
In reply to @northoftheborder "@kujhawk1978 Exactly. And just to add a bit to that, MDT is one of the pillars..." + (show)
Profile picture for northoftheborder @northoftheborder

@kujhawk1978 Exactly. And just to add a bit to that, MDT is one of the pillars of the new approach to treating oligometastatic prostate cancer.

In Ye Olden Days (i.e. up to ~5 years ago), most oncologists approached all metastatic prostate cancer the same way: the goal was sequentially-escalating palliative treatment (ADT to ARSI to chemotherapy to the final pain killers) to slow the disease's progression and maintain quality of life until it inevitably killed you in 3–5 years (maybe 7 if you were young and healthy).

Now, things have changed dramatically. Many oncologists distinguish by metastatic load: oligometastatic for just a few metastases (typically under 3–5), polymetastatic for more.

For oligometastatic prostate cancer, they hit it with everything they have up front:

- radiation on each individual metastasis (MDT)

- systemic therapy (ADT+ARSI), and increasingly,

- a large "curative" dose of radiation to the prostate, aka "mothership" as well, to keep from supporting any new or existing metastases.

It's an open debate right now whether oligometastatic prostate cancer can be fully "cured" rather than just managed long term, but studies are showing huge improvements in overall survival and progression-free survival from this new, aggressive approach, applying "curative intent" to treatments for oligometastatic PCa.

(Note: there have also been revolutionary changes in the strategies for treating polymetastatic PCa, but that's not the subject of my post; seach for "triplet therapy".)

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@northoftheborder Thanks. I have oligometastatic (a lymph node, and maybe a seminal vesicle - TBD). Consulting with my RO at Johns Hopkins yesterday, I asked directly where we are headed with my treatment - i.e., whether our goal is cure or lifelong management. His answer was a definite "cure". Things have come a long way.

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northoftheborder | @northoftheborder | 5 days ago
In reply to @guybe "@northoftheborder Thanks. I have oligometastatic (a lymph node, and maybe a seminal vesicle - TBD). Consulting..." + (show)
Profile picture for guybe @guybe

@northoftheborder Thanks. I have oligometastatic (a lymph node, and maybe a seminal vesicle - TBD). Consulting with my RO at Johns Hopkins yesterday, I asked directly where we are headed with my treatment - i.e., whether our goal is cure or lifelong management. His answer was a definite "cure". Things have come a long way.

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@guybe That's great! Many ooncologists are still reluctant to say "cure" for oligometastatic prostate cancer, but that seems to be the way things are moving (a functional cure, not necessarily a complete one).

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dantewedge | @dantewedge | 5 days ago

Thanks all!!
I just got my Eligard shot.
I didn’t have option of pills because I’m in Thailand for treatment. But, I go back to the states for a few months and will talk to doctors there, as well. Had to get something started. Doc here says he will do this 3-month injection and then another in 3 months right before SBRT.
Anyway, I got a blood panel done today for comparison of the current PSA and testosterone levels.
If I don’t react well to the Rligard then I’ll try to get the pills in America or another country, as I have international insurance (not sure if they will cover but…?)

Glad to find this forum…all the tests have led to this initial treatment .
Relieved to be starting finally…

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2 replies
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jim18 | @jim18 | 5 days ago
In reply to @dantewedge "Thanks all!! I just got my Eligard shot. I didn’t have option of pills because I’m..." + (show)
Profile picture for dantewedge @dantewedge

Thanks all!!
I just got my Eligard shot.
I didn’t have option of pills because I’m in Thailand for treatment. But, I go back to the states for a few months and will talk to doctors there, as well. Had to get something started. Doc here says he will do this 3-month injection and then another in 3 months right before SBRT.
Anyway, I got a blood panel done today for comparison of the current PSA and testosterone levels.
If I don’t react well to the Rligard then I’ll try to get the pills in America or another country, as I have international insurance (not sure if they will cover but…?)

Glad to find this forum…all the tests have led to this initial treatment .
Relieved to be starting finally…

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@dantewedge Cost of Orgovyx in Canada is 10% of the US cost (about $215/mth vs $2150/mth) before insurance in case you are near the border or route through Vancouver.

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dantewedge | @dantewedge | 5 days ago
In reply to @jim18 "@dantewedge Cost of Orgovyx in Canada is 10% of the US cost (about $215/mth vs $2150/mth)..." + (show)
Profile picture for jim18 @jim18

@dantewedge Cost of Orgovyx in Canada is 10% of the US cost (about $215/mth vs $2150/mth) before insurance in case you are near the border or route through Vancouver.

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@jim18 Thanks!! Im in SE Asia but heading back to the States for about 6-7 weeks. But a trip to Canada, or any other country the meds are available for that difference in price! lol.
My doctor here says my PSA counts are very low so I shouldn't have the flares, etc.. And the plan is only the 2 injections....once every 3 months. I'll see how this first month or so goes. But if it isn't good then I'll probably switch over to the pills, if possible. Thanks for the information!!

PS - I've started a workout regimen and diet to try to combat some of the side effects. Looking at supplements, etc. to help with the nutrients.

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