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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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@carlsbadguy
Coverage duration does not mean that they will not cover past that, if the doctor says you need it.
@jeffmarc
You're correct, the thumbnail in the post has the first 3 letters cut off, however if you click on the thumbnail the full image opens and shows the Coverage Duration 1 year. I always have to click on thumbnails posted in this forum, they're too small for me to read.
I read Coverage Duration 1 year as meaning they will only pay for the drug for one year, and according to Medicare they are allowed to set time and quantity limits. I will call them to clarify before open enrollment. If need be I will find another Part D provider who will cover it starting in January.
@jime51
Thanks very much I appreciate the video! While I don't know the options if the cancer does not respond to the treatment or in returns, my mindset is similar. Not looking to several years where the cure is so difficult and uncertain.
@carlsbadguy
I expanded it rather than opening it sure enough, next time!
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1 Reaction@carlsbadguy
So many people with advanced prostate cancer need to stay on ADT for 18 to 24 months, this just doesn’t make sense to me that they would have a limit like that.
If you’ve been on here long, you’ve seen it many times, people with many months.
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1 Reaction@jeffmarc
I understand Jeff, I've only been on here since my diagnosis in April and am aware of many people on these drugs for 18 to 24 months and other drugs for years. The Part D plan I was on for 7 years more than doubled in price for 2026, I got upset, shopped around and ended up with a plan than costs peanuts as far as premiums go and with a $615 deductible. I have essential tremors, one of the drugs I have taken for years they refused to fill the full prescription. It took 2 months of going back and forth between the Drs office and insurance provider to get the number of pills I need, they had a "quantity limitation". They finally caved and gave me the additional pills I needed, and it is not an expensive drug. I'm not confident they will continue to pay for a $2000+ a month drug when their coverage formulary states they will only cover it for 12 months. You may be right, I may be totally wrong, time will tell.
@carlsbadguy
I sure hope they do pay for it. Good luck.
I didn’t think it was so easy to move around with supplementals they have requirement to take you if you get them with a certain amount of time of dropping your previous one?
I have great Supplemental Health Insurance, Part D drug coverage is separate. Open enrollment for both Supplemental and Part D is November 1 through Dec 15th for the following year. There is no underwriting, if need be I will simply find a new Part D provider who has Orgovyx in their formulary. starting Jan 1 2027. All of the injectable drugs are covered by Medicare Part B, or a Medicare Advantage plan because they are done in a clinical environment, either a Drs office or an infusion center. Pills like Orgovyx are covered by Part D. I'll have to pay the 2027 Medicare Part D max out of pocket, ($2200-$2400 they haven't announced it yet) then the rest of the year it will cost me $0.
@carlsbadguy
I shopped Part D last fall and downloaded the formularies. I did not have PC at the time but the three plans of interest: Wellcare, Humana and Aetna/SilverScript all had Orgovyx. Premiums ranged form $0-$95/month in my state. The wildcard is pre-authorization. Orgovyx is a Tier 5 drug on all of them and no way (that I have found) to see how difficult it is to get approval. I also don't remember if there is a limit on the number of month they will cover and this could change for this year during open enrollment.
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1 Reaction@tbgb50 said: "2. the urologist said I will not know for a year whether the ADT and radiation worked."
Well now, maybe you won't know for a year, if that's what he thinks the proper time period is, but if you stopped ADT after six months, you would also find out at one year if THAT worked! IOW the treatment period and the evaluation period do not have to be the same. Just sayin'.