Hormone Therapy

I have been on ADT for almost 8 years. Orgovyx for the last year or so. Yes, you can expect brain fog if you stay on ADT long enough. It’s not just ADT, however, zytiga, apalutamide and Enzalutamide all can cause further brain fog. Darolutamide is the only one that doesn’t cross the blood brain barrier.

I have brain fog. I can’t remember the names of things, people just about everything, But it’s not like dementia. I find that I can use words to get around what I can’t remember, Though it will come back to me within a minute or two, most of the facts I know are clear as could be, Just don’t ask me the name of the doctor that told me those facts, most of the time. I can’t immediately remember the names of actors or politicians that I know very well, I will say a name one time and then it will not be there to say it again.

I have found you can get around this brain fog almost all the time. When I forget a word, I can describe the person or the object in great detail until I could find it on the web or somebody you can tell me the name.

It’s not like you lose your way home. You might forget the name of the street a block away, But that doesn’t matter because you know how to get home and most people can read a map To get street names if they forget.

The brain fog is more annoying than life changing.

Having just been prescribed Orgovyx + Nubeqa It’s a little disquieting that my doctor rejected using just one of that combo. According to him, studies show combinations keep therapy to be more effective in PSA suppression over time and other metrics. (That is if you survive the side hustle effects). Has everyone on Orgovyx alone had success in keeping PSA down during or after taking it? Anyone who hasn't? One of the toughest parts of cancer is deciding on the treatment. Appreciate any feedback.

It’s been demonstrated in many clinical trials that - depending on the nature of the prostate cancer - doublet therapy has better outcomes than monotherapy. (The attached graphic shows a few of those clinical trials.) Treatments have advanced greatly since I was first diagnosed in 2012.
Side-effects of ADT are greatly minimized by resistance-training.

Thanks @brianjarvis The information you provided is helpful.
However, @lsk1000 you indicated in another discussion thread (Lupron, June 14) that you "don't think/don't know" if you are considered metastatic, and based on the description you provided, @northoftheborder replied on the same day, "No, you are not metastatic.
I noted that the "Doublet" Therapy OS benefits mentioned in the Phase III trial are for "mCSPC," or metastatic castration-sensitive prostate cancer -- a type of prostate cancer that has spread to other parts of the body and still responds to hormone therapy.
If I were you, I will ask my oncologist why I need double therapy when I'm not metastatic. I was Gleason 7 (3+4) on three of 14 cores, Gleason (0+2) on four cores, intermediate risk. I had 5-fraction SBRT in April 2025. My RO prescribed for me Orgovyx only. I'm on my fourth month now, RO said that we would see if I could get off Orgovyx after 8 or 12 months. I have read in some posts in this support group that six months ADT is about standard; I'm inclined to tell my RO that I want to stop ADT after 8 months, and not over treat.

Looks like you have a typo and I’d like to hear the right score

I am sure you didn’t mean Gleason 0+2. Was that supposed to be 4+3?

You wrote
“Gleason 7 (3+4) on three of 14 cores, Gleason (0+2) on four cores”

GS 7 on 3 cores
GS 2 on 4 cores
Negative on 7 samples

Unfavorable intermediate said the urologist. The physician assistant at the cancer center said maybe it's because "not less than half of the 14 samples were positive." As a layman, I thought I was favorable intermediate, since GS 6 (3+3) is not cancer, why do the four (0+2)'s make me unfavorable? And so, I have to be on Orgovyx 8 months to a year, instead of 6 months only?

I have been on Orgovyx for 3 months. None of my side effects are severe but I have fatigue, brain fog, headaches, occasional hot flashes. It has been effective, has reduced my psa 98 to 99%.

Phil

Between 98% and 99% is what I meant. Am down from psa of 31 to .37

It’s the total quantity of 3+3 and 3+4 that they find that makes the decision in some cases. One of the Seminars I attended discussed this issue. They said if there were more than 5 cores (including 3+3) are found to have prostate cancer, Then, even if it was all 3+3 it was not favorable.

It’s true that in some cases with only two 3+4’s you can consider active surveillance. The thing is, she didn’t say what percentage of cancer was found in each core of the biopsy. A higher percentage can also show you need more treatment. That could be what the doctor went by.

Unless you have some other illness or condition running along side your cancer that is debilitating, go ahead and drive yourself. Nothing with radiation or ADT will get in the way of driving. Finishing 6 months of Orgovyx in 10 days and did 25 rad sessions. Brain fog left me searching for a word during conversations which usually presented itself after 3-4 seconds. I would suggest not over thinking nor projecting on it. All of us have different side effects.