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Lupron or Not at 76?
Background - biopsy in 2022 was completely clean. Biopsy in 2026, Gleason 9. PET shows cancer is localized.
Had first appointment with oncologist yesterday. Recommended 5 weeks of Photon radiation treatments and 2 years of Lupron. I'm fine with the radiation but:
I was told the success rate is 80% for the radiation and another 5% with the Lupron. One problem is the 80% success rate is not based on age groups so it's difficult to decide if the Lupron is worth it because:
I was told at 76 the 'recovery period' for Lupron = the amount of time you get the treatment. So 2 years of treatment + 2 years of recovery = 4 years. I'd be 80 and I was told at this age you often don't see the side effects of Lupron reverse so it seems high risk for not much reward.
Am I thinking about this correctly?
Has anyone roughly my age gone with Lupron and really regretted it? Why
THANKS!
FWIW at this point I need to decided between:
Radiation only
Radiation + 1 year of Lupron (my idea)
Radiation + 2 years of Lupron (recommendation from urologist and oncologist).
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@tbgb50
I have Wellcare Value Script, premiums are peanuts. Orgovyx is a Tier 5 drug, and from what I can tell there was no prior authorization required. When you put Orgovyx into the formulary tool, it comes up with the text box I posted above, Tier 5 and Provider Restrictions: Coverage Duration 1 Year. I've just started radiation, I know I'm covered through the end of the year at no cost as I've met the $2100 max out of pocket for 2026. I'll deal with next year during open enrollment starting Nov 1.
I have the same plan. I'll check the website but the formulary from last October (for 2026) shows:
ORGOVYX ORAL TABLET 120 MG: PA-NS; LA; QL
PA-NS stands for Prior Authorization for New Starts: This means that if this drug is
new to you, you will need to get approval from us before you fill your prescription.
If you are taking this drug at the time of enrollment, you will not be required to
meet criteria for approval.
Hopefully approval is not a pain.
IDK. I'm taking ADT 6 months at a time. If you are on Lupron you would get your second shot in 6 months so you would be at 'full strength' for 12 months. I really don't want to restart anything especially since mine is aggressive.
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1 Reaction@tbgb50
I was on six months Lupron Shots for six years. I switched to Orgovyx And for the first five months, I didn’t get any hot flashes then they came back but just a little bit milder than with Lupron.
Since Lupron already has your testosterone down below 20, switching to orgovyx is not likely to make any difference. I sure prefer taking a pill once a day.
@tbgb50
My oncologist got a "Coverage Determination" which was expedited and approved. I'm not sure what LA stands for but I'm pretty certain QL stands for Quantity Limits, which if I understand it correctly means "Coverage 1 year". I'll talk to my oncologist to see if there was a limit on the number of months when he got the coverage determination. I'll also talk to Wellcare, and if they only cover the drug for 12 months total, I'll switch plans for 2027.
@carlsbadguy
You are correct about QL though I did not see how many months in total in the formulary.
LA stands for Limited Access - you have to get the prescription filled through a specialty pharmacy. I do not know but suspect the specialty pharmacy varies by where you live. You have to get the name of the pharmacy on the Wellcare website and it may change from time to time. No idea if they deliver or send by mail.
@jeffmarc
Without no idea where I will be in a year or two, I decided to get started with a 6 month Lupron shot and depending on how it goes, switch to Orgovyx for 12 months. So a total of 18 rather than 24 months.
I just got the shot yesterday so I haven't felt the side effects yet. Also, based on one of your earlier comments, I was glad the doctor prescribed Casodex without me having to ask. I never heard of this before so thanks!
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I see that you decided on Lupron, at least for six months. I hope you do well while on it. I'm in the Scripps Hospital network here in San Diego. They have their own specialty pharmacy, they call me 2 weeks before I need to have a new Orgovyx prescription filled, set a date and time, and it is hand delivered to me. They set this all up, I didn't need to go through Wellcare.
BTW: QL or Quantity Limits may also stand for how many pills per month they will cover. I ran into this with another drug I take, they didn't want to cover the amount my Dr prescribes for 90 day mail order, I appealed and after two months of back and forth with them they approved.