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Doublet Therapy Holiday - Option for Oligorecurrent Prostate Cancer?

Posted by keno2087 @keno2087, 3 days ago

My dad was originally diagnosed with Gleason 7 (4+3) prostate cancer in Dec. 2019. After a RP and IMRT over the course of the next few years, his PSA began to rise at the start of 2024. He was treated a year ago for oligorecurrent prostate cancer (2 small spots on his spine) after his PSA reached 0.5 with SBRT.

He has been on Eligard and Nubeqa for almost a year now as well and was tolerating it well enough with his PSA being below 0.1 for the last 10-11 months. He had a TAVR done to treat severe aortic stenosis in April 2025 however as he felt some chest pain at the start of the year which found the stenosis. The procedure was a success but he still has occasional bouts of angina when exerting himself too much. We've discussed potentially stopping his doublet therapy after 18 months to see if this improves but since he's metastatic, I'm worried this isn't a good idea.

Anyone take a break from hormone therapy despite being oligometastatic? If not a good idea, I have a feeling we'll need to consult with a cardio-oncologist (already sees a cardiologist who is scheduling him for a stress test soon as structurally nothing seems wrong with the heart).

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northoftheborder | @northoftheborder | 1 day ago
In reply to @jeffmarc "@trchar yes, I am on both. With Nubeqa I’ve been undetectable for 23 months, Something that..." + (show)
Profile picture for jeff Marchi @jeffmarc

@trchar yes, I am on both. With Nubeqa I’ve been undetectable for 23 months, Something that was pretty much a failure with Zytiga. I am on Orgovyx because it is cheaper than Lupron where I get treated.

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@jeffmarc wrote "I am on Orgovyx because it is cheaper than Lupron where I get treated."

In Ontario, Orgovyx is priced almost exactly the same as Firmagon (about US $235/month at the current exchange rate) to keep it competitive. I assume Lupron is priced similarly, allowing for the fact it's every 3 months.

That's all assuming one had to pay full retail, with no government or private health insurance.

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trchar | @trchar | 1 day ago
In reply to @jeffmarc "@trchar yes, I am on both. With Nubeqa I’ve been undetectable for 23 months, Something that..." + (show)
Profile picture for jeff Marchi @jeffmarc

@trchar yes, I am on both. With Nubeqa I’ve been undetectable for 23 months, Something that was pretty much a failure with Zytiga. I am on Orgovyx because it is cheaper than Lupron where I get treated.

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@jeffmarc that’s great nubequa seems to be working really well for you, congrats and continued success keeping your PSA very low. Based on your experience if/when I go CRPC I will request continue orgovyx and add nubequa. Again thanks.

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Profile picture for jeff Marchi
jeff Marchi | @jeffmarc | 1 day ago
In reply to @northoftheborder "@jeffmarc wrote "I am on Orgovyx because it is cheaper than Lupron where I get treated."..." + (show)
Profile picture for northoftheborder @northoftheborder

@jeffmarc wrote "I am on Orgovyx because it is cheaper than Lupron where I get treated."

In Ontario, Orgovyx is priced almost exactly the same as Firmagon (about US $235/month at the current exchange rate) to keep it competitive. I assume Lupron is priced similarly, allowing for the fact it's every 3 months.

That's all assuming one had to pay full retail, with no government or private health insurance.

Jump to this post

@northoftheborder
I always got 6 Month Lupron shots. A couple of years ago they started charging $400 for every shot. I get Orgovyx for free, since Darolutamide uses up my $2000 Medicare limit in January. Lupron is not covered by that limit.

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