Is PSA rise inevitable after hormone therapy?

Orgovyx is pills rather than an injection. The main chronic side effects are the same (low testosterone is low testosterone), but the acute side-effects that I had after every Firmagon injection aren't there (swelling at the injection site, a fews days of flu-like symptoms, etc) and your testosterone recovers faster when you stop.

The estradiol patch or gel has been found to be just as effective as ADT in reducing testosterone. Estradiol has fewer side effects, Less bone loss, and reduced hot flashes.

Look up the Patch Trial for more info.

Orgovyx is oral. Same ADT effect but hopefully less side effects; faster recovery is well documented.

There's really little reason for most people to still be going through the discomfort of ADT injections any more, except that some insurers don't want to pay the extra $$$ for Orgovyx

(Exceptions: prostate-cancer patients with dementia or other cognitive disorders, where it might be beneficial for the doctor to give the injection to make sure the patient is getting their ADT, and the small number of patients who don't respond to GnRH receptor antagonists.)

So I have a question: I watched a video produced by Dr. Eugene Kwon at the Prostate Cancer Research Institute discussing hardening of resistance by long-term use of suppressive forms of therapy. "We strongly prefer taxane-based chemotherapy for initial treatment after a patient has failed both hormone therapy and an ARPI agent." Thoughts?

Sorry, that’s a question way above my scope of knowledge. @jeffmarc or @northoftheborder or @stevecando will probably know.

Hormone therapy and ARSI are still working for me. I don't know for sure what we'll do if/when they "fail" (which is what Dr Kwon is discussing, according to @nparadisum).

I'd think chemo and/or Pluvicto might end up being good options, or maybe trying a different -lutamide. Or maybe I'll never get there, or at least won't until there are new treatment alternatives.

Also, if there are only a couple of hotspots on a PSMA PET scan, we might be able to radiate them directly and reset the clock, so to speak.

A quick Google and the answer is Docetaxel, which is already extensively used in triplet therapy or alone after ADT failure.
Many on the forum have used this drug and reported success; also, the fearsome side effects of “chemo” seemed to be felt to a lesser degree by most patients.
Having not gotten to that stage myself ( hopefully NEVER🤞) I was not familiar with the taxane family of drugs, sorry…

Yes, the triplet of chemotherapy + ARSI (like one of the -lutamides) + ADT (like Orgovyx) seems to be the cutting-edge standard of care for polymetastatic prostate cancer these days.

For oligometastatic, spot radiation to the individual metastases seems to be preferred over chemo, but I'm sure there are many exceptions.

I was going to change from Lupron to Orgorvyx but haven't had anything higher than a warm flash with zero sweats. My concern is Orgovys will trigger them. Rethinking changing. With high-risk cancer I might benefit from a slower ADT recovery.