Adverse Heart conditions from Hormone therapy

My husband , Gleason 9. PSA 46.6, did Zytiga /prednisone for 12 months and Orgovyx 18 months.
During that time he developed unstable BP, an aortic root aneurysm grew and he developed moderate to severe aortic valve regurgitation.

He is now scheduled for open heart surgery in August at Mayo, to have the aortic valve replaced and the aneurysm repaired.

Pretty sure the ADT made things worse

It may have been the ADT (Orgovyx) or it may have been the ARPI (Zytiga: Abiraterone).
Of the ADTs tested, Orgovyx was demonstrated to have the least chance of cardiac issues (though the risk was not zero).
Cardiac issues are also a known (but, again small) side-effect of Zytiga. (See attached chart.)

Yes, we picked Orgovyx for several reasons, to include less cardiac risk . Zytiga can raise BP ( which it did ) which of course didn’t help the aneurysm. It took quite a while after stopping Zytiga for his BP to stabilize. Had to double losartan and add a beta blocker.

While ADT could’ve made things worse, Zytiga was almost definitely the culprit here. I was on ADT for 2 1/2 years and had no problems at all with blood pressure. I know many other people on ADT without any issues with blood pressure.

I know a lot of people on zytiga, many have high blood pressure as a result, Including me. Zytiga caused Me to have four Afib Events, The third one putting me in the hospital for four days with a pulse of 175 if I stood up. Also caused a lot of skipped beats. I quit Zytiga two years ago and my blood pressure has stabilized and I no longer have afib problems doing the same thing that caused Afib when I was on Zytiga.

Glad you’re better…
Zytiga can be very toxic … My husband stopped all his meds earlier than original treatment plan required … at this point more likely to die from heart disease than prostate cancer

For someone who has heart problems, but needs to be on treatment you should consider Nubeqa As a single drug. I did it for a while and I know a few people that have done it for over two years and it has kept the PSA undetectable.

Ask a doctor about this, It could be appropriate after surgery.

Thanks for the recommendation…

Fingers crossed, he will not need it , for awhile at least.

Huh? I’m glad you are doing well with a single drug. My doctor (Mount Sinai) just prescribed Nubeqa + Orgovyx. I asked if I could take one or the other. He said studies show combinations keep PSA down longer and were overall better for long term survival. (If the side effects don’t kill you first).
He said combination therapy was the standard of care now. I wonder which way is better?

The Embark trial studied Enzalutamide And Lupron. They wanted to find out what drug/combination worked the best. They found the two together worked the best, Enzalutamide Alone worked next best and Lupron alone worked the least best (Awkward). Doctors consider that Darolutamide Is similar enough to be substituted for Enzalutamide.

This was a case where the person could not handle ADT so a single drug that would work best seems to be Darolutamide. I say that based on a number of people I know over at Ancan.org That are using it standalone. It worked great for me while I was off Orgovyx for eight months.

The two together are preferable, according to that study.

Nubeqa (darolutamide) is approved for use in both non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-sensitive prostate cancer (mCSPC). I am neither. Scans showed only showed tumor activity in vas deferens stump, nowhere else. Lupron has worked for me in the past, so can’t we assume ADT will still work? That means I am non -metastatic castration sensitive which is not in either category it is approved for? The Embark study and others did not focus on non-metastatic castration sensitive. Then again Orgovyx is approved for the same two classifications. I can’t help wondering if either one would be ok, rather than the twofer.