Optimal Duration of Hormone Therapy

My head is spinning! At a center of excellence along with 40 IMRTs I was prescribed 24 months of ADT (Orgovyx, Zytiga, Prednisone) for stage N1 metastatic hormone sensitive prostate cancer. Due to the annoying side effects I asked my MO if I might change from Zytiga to Nubeqa and reduce these treatment time to 18 months. She advised me she'd rather me continue with the Zytiga and endure the full 24 months. I assume being high risk and the treatment working well makes sense not to mess with success. PSA has been <.05 for many months. I sure am looking forward to getting off the ADT. Opinions on whether her recommendation sounds like a logical one?

@swl1956 I cannot speak to the treatment plan you are on, other than to suggest a few things that are usually considered whenever embarking on ADT. Have you had a baseline bone density scan done? If not you should request that it be done. I did and found that I had osteoporosis . 24 months will impact your bone health so supplementing with calcium and vitamin d is generally used. Also if trying to maintain or preserve your sexual health, a penile pump and daily dosing of 5mg viagra is often used. I exercise strenuously twice a week for nearly 2 hours. The goal is to preserve muscle mass. On YouTube look for videos by Doctor John Mulhall, a sexual health urologist at Sloan Kettering.

@swl1956
I was on Zytiga for 2 1/2 years. In that time, I was only undetectable one month. It gave me high blood pressure, Many hot flashes, And multiple Afib Events where I had to go to the emergency room and be Cardioverted (Shocked back into normal rhythm).

It did give me 2 1/2 years, however. I moved on to Nubeqa And I’ve been undetectable for 31 months. I have had 16 years with PC, And since I have BRCA2, it is very aggressive. Zytiga gave me 2 1/2 years of the 16.

What I’m getting at is that having prostate cancer become a chronic disease can depend on you being willing to use a drug that is difficult but allows you to live longer so you can see more drugs come out that can give you an even longer future.

You can take Nubeqa As your next drug, If you need it.

@jim18
The prices I quoted are the payments to the pharmacy, my insurance plan reimburses me 85% of that amount. I see you can have prices less than what I pay. However, I am in Panama and my doctors do not have prescribing rights in the Untied States. While your prices on this drug are lower that what I pay in Panama the reverse is true for other drugs. For example I pay about $400 for the 6 month injection of Prolia, Amazon has that for $1,920. As to changing my insurance plan that is not an option. I have an employer plan carried into retirement. The benefits are good especially since I am overseas. The plan covers allowable costs at 85%. Oh, no prior approval for services except long term care. The only benefit I am lacking is the Medicare limit of $2100 on annual medication costs. You did mention calculators to adjust A1C for anemia. I searched for that an fialed to see any. Do you have a source?

@oldgreenpaint
Thanks oldgreenpaint. I did have a Dexa scan done at 12 months into my ADT regimen. So far it was normal for my age. I have been supplementing calcium and vitamin D. I have been walking regularly about 3 miles a few times a week and do 10 pushups daily, but although I know I should be strength training I haven't been doing that.

Jeff,
Thanks for reply! I guess I'm lucky so far, no serious side effects. Just the typical hot flashes and fatigue. Anyhow, I had read Nubeqa has less side effects and yet when I asked to be switched to it from Zytiga my MO was not very supportive and talked me out of it. The fact that I've been in the undetectable PSA range however has some merit as to keep with what is working. I especially don't like taking the prednisone. As you suggest, we can take some solace knowing there are several tools to keep us from succumbing to Pca.

@swl1956 Unless you have heart issues or some other justification, I doubt any insurance company is going to pay 20x+ for Nubeqa as generic Zitiga. Probably why your doctor does not even want to try. You did not say how many months in you are except that it is 12+. If you want it to be ,24 months that is your choice. No doctor can force you to continue. All studies show decreasing benefit as months are added. A few recent ones show zero or even negative benefit when non-PCa factors are included. As long as the NCCN has 24 months as a standard of treatment most doctors will not tell you to stop. No risk to them if it leaves your bones hollow but they could have a malpractice suit if you have a recurrence shortly after stopping. Therefore, you will need to take charge of your own treatment with respect to months of ADT.
As mentioned, you should be doing weight exercises to keep muscle, high impact to maintain bone, and take low dose Tadalafil 5mg (no Viagra at that dose),
Wish your treatment is a success.

@jim18
If the doctor prescribes it the insurance company will usually pay for it. I know a lot of people that have switched over. The side effects can be a significant reason, I haven’t heard one in this case. You are right however some insurance companies can be really tight.

@jim18
I have completed just about 18 months of ADT plus ARPI. I could be wrong, but I didn't get the feeling that it was a cost issue to get the darolutamide. In fact, she mentioned that their institution has a very good track record at getting insurance approvals. Being my Dexa scan was good and PSA is undetectable I'll likely not pursue shortening the regimen at this point. The side effects I'm dealing with are annoying but have been tolerable. In fact, this may sound silly, but as much as I am looking forward to getting off ADT, I'm worried as to what will happen when that happens.

@swl1956 Then it might just be you do not seem to have many issues with the Zytiga. The ADT/ARSI suppress the PSA so you cannot tell how effective your treatment has been until a few months after you go off of them. I think everyone is apprehensive at that point. It is not unusual for the PSA to be detectable (more with 4-6 vs. 24 months ADT). Then need to wait another few months to make sure the PSA is still moving down.