1. < Prostate Cancer
Profile picture for johnl777

Metastatic M1A survival and ED impact, Eligard and Zytiga ADT only

Posted by johnl777 @johnl777, Jul 22 5:45am

Had a biopsy 6/20/2026, Gleason 8 (4 + 4) and had pmsa PET scan 7/15/2026. Just received a diagnosis of M1A on 7/17/2026. 5 lymph nodes in the pelvic area, and one just above the pelvic area, regional. Told that surgery or radiation are no longer an option, now only whole body systemic treatments are viable. Urologist recommended ADT treatment only with two drugs, Eligard and Zytiga. I'm 63 and then otherwise good health. From my research, the 5-year survival rate is 85% or maybe even better at my age and health. Any other better or new treatment options? Other than the obvious greater concern for my life, does anyone have any insight on erectile impact? I've heard that it takes away desire, but is it still possible to get an erection with Viagra or Cialis? Also, has anyone had success with the direct penile Trimix injections? These don't require testosterone to work.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for johnl777
johnl777 | @johnl777 | Jul 22 6:25pm
In reply to @lag "@johnl777 I don't think any Mayo doctors monitor this forum, and I have never seen one..." + (show)
Profile picture for lag @lag

@johnl777 I don't think any Mayo doctors monitor this forum, and I have never seen one post comments here. The forum is monitored by Mayo employees and volunteers who do not offer medical advice.

Jump to this post

@lag

Thank you for sharing that.

REPLY
Profile picture for johnl777
johnl777 | @johnl777 | Jul 22 6:33pm
In reply to @stage4lovolmetpc "Hello John, Same numbers as yours, GS8, 4+4, multiple lymph nodes, no organ or bone mets...." + (show)
Profile picture for stage4lovolmetpc @stage4lovolmetpc

Hello John, Same numbers as yours, GS8, 4+4, multiple lymph nodes, no organ or bone mets. On Orgovyx and Zytiga w/prednisone since Feb 2026, switched to Nubeqa with Orgovyx last month. Much better! My MO also said no radiation and that Pluvicto would be in my future, perhaps in a year or two. Im good with that but I am 72yo as opposed to your 63. I can say that erections are still possible, it is just that I have no interest...lol. Im good with that also. I am making the best of the situation with as little treatment as possible, the side effects that may come with radiating the prostate really had me worried. If the cancer gets into my bones Ill consider radiation to the mets then. Exercise, eating right and enjoying the time I have left are my main focus now. For me, quality of life is most important, Im not going to spend the next 5 years being miserable just to live a few more months. Thanks for your post John, I will be interested what your Doc has to say in August.

Jump to this post

@stage4lovolmetpc

Thank you so much for sharing your experience and the specific information. I'll be discussing the drugs, especially what you and others have said about the change with Nubeqa with Orgovyx, and also Pluvicto. This is extremely helpful. Thanks again. Greatly appreciated. Hope all continues to go well with your treatment.

REPLY
Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | Jul 22 6:47pm
In reply to @johnl777 "@jeffmarc Hey Jeff, I'm glad that you are doing well and have been doing well for..." + (show)
Profile picture for johnl777 @johnl777

@jeffmarc

Hey Jeff, I'm glad that you are doing well and have been doing well for years, that is awesome, and also very encouraging. Great to hear the change in your meds has alleviated the side effects you were experiencing. I appreciate you providing a specific RX names. I'll address the specific drugs with my treatment team and share your comments. I have been on blood pressure meds for 20 years. It does concern me that you were having BP/afrib events. I'll specifically discuss this as well. Thanks again for your insight. Greatly appreciate it

Jump to this post

@johnl777
I am now on three different blood pressure medicines, one of which I’ve been able to reduce in strength because I’m no longer on Zytiga. I have to take Diltiazem, Losartan and metoprolol Twice a day. I’ve had 5 afib events due to it, They were able to Cardiovert me four times but one time it didn’t work and I ended up in the hospital for four days.

Not everybody has those problems with Zytiga, but it is very hard on the heart so they don’t recommend it for people with heart issues.

REPLY
Profile picture for xahnegrey40
xahnegrey40 | @xahnegrey40 | Jul 22 9:02pm

Listen to Jeff Marchi and others on this site- they know the drill...my observation is get on the ADT drugs- I am surprised radiation is not on menu but maybe it should be. Dont worry about sex for now- take a break..but get on top of your treatment right away.. the ADT will definitely put the brakes on the cancer...good luck !

REPLY
1 reply
Profile picture for swl1956
swl1956 | @swl1956 | Jul 22 10:17pm

Diagnosed with 4+3 stage 4a mhspc and after being treated with IRE focal ablation, metastasis was discovered in pelvic lymph nodes. At a Philadelphia center of excellence (Fox Chase Cancer Center) I was immediately put on ADT and ARPI. Orgovyx and Zytiga w/Prednisone. Then had 40 sessions of IMRT total 80gy. I've been enjoying non detectable PSAs for over a year now. In my opinion it seems radiation to the primary tumor and pelvic lymph nodes should be included in your treatment. I would also ask for Orgovyx as your ADT and Nubeqa for ARPI. These drugs may be more expensive but have several advantages over injectable ADTs and Nubeqa is known to have less side effects than others ARPIs. The required Prednisone with Zytiga gives me grief, especially insomnia. Anyhow, I know dealing with these decisions is incredibly stressful. Ask lots of questions before committing and I would highly recommend a center of excellence cancer institution.

REPLY
2 replies
Profile picture for swl1956
swl1956 | @swl1956 | Jul 22 10:20pm
In reply to @swl1956 "Diagnosed with 4+3 stage 4a mhspc and after being treated with IRE focal ablation, metastasis was..." + (show)
Profile picture for swl1956 @swl1956

Diagnosed with 4+3 stage 4a mhspc and after being treated with IRE focal ablation, metastasis was discovered in pelvic lymph nodes. At a Philadelphia center of excellence (Fox Chase Cancer Center) I was immediately put on ADT and ARPI. Orgovyx and Zytiga w/Prednisone. Then had 40 sessions of IMRT total 80gy. I've been enjoying non detectable PSAs for over a year now. In my opinion it seems radiation to the primary tumor and pelvic lymph nodes should be included in your treatment. I would also ask for Orgovyx as your ADT and Nubeqa for ARPI. These drugs may be more expensive but have several advantages over injectable ADTs and Nubeqa is known to have less side effects than others ARPIs. The required Prednisone with Zytiga gives me grief, especially insomnia. Anyhow, I know dealing with these decisions is incredibly stressful. Ask lots of questions before committing and I would highly recommend a center of excellence cancer institution.

Jump to this post

Oh yeah! I forgot to mention that so far everything works sexually except that I absolutely have no desire while on these drugs

REPLY
Profile picture for johnl777
johnl777 | @johnl777 | Jul 23 7:51am
In reply to @xahnegrey40 "Listen to Jeff Marchi and others on this site- they know the drill...my observation is get..." + (show)
Profile picture for xahnegrey40 @xahnegrey40

Listen to Jeff Marchi and others on this site- they know the drill...my observation is get on the ADT drugs- I am surprised radiation is not on menu but maybe it should be. Dont worry about sex for now- take a break..but get on top of your treatment right away.. the ADT will definitely put the brakes on the cancer...good luck !

Jump to this post

@xahnegrey40

Thank you very much for your insight and encouragement. I will be discussing the suggestions others have made with the oncologist on 8/7. I hope all is going well with you and your treatment. Thanks again!

REPLY
Profile picture for johnl777
johnl777 | @johnl777 | Jul 23 8:00am
In reply to @swl1956 "Diagnosed with 4+3 stage 4a mhspc and after being treated with IRE focal ablation, metastasis was..." + (show)
Profile picture for swl1956 @swl1956

Diagnosed with 4+3 stage 4a mhspc and after being treated with IRE focal ablation, metastasis was discovered in pelvic lymph nodes. At a Philadelphia center of excellence (Fox Chase Cancer Center) I was immediately put on ADT and ARPI. Orgovyx and Zytiga w/Prednisone. Then had 40 sessions of IMRT total 80gy. I've been enjoying non detectable PSAs for over a year now. In my opinion it seems radiation to the primary tumor and pelvic lymph nodes should be included in your treatment. I would also ask for Orgovyx as your ADT and Nubeqa for ARPI. These drugs may be more expensive but have several advantages over injectable ADTs and Nubeqa is known to have less side effects than others ARPIs. The required Prednisone with Zytiga gives me grief, especially insomnia. Anyhow, I know dealing with these decisions is incredibly stressful. Ask lots of questions before committing and I would highly recommend a center of excellence cancer institution.

Jump to this post

@swl1956

Thank you for the detailed information on your treatment. Others have made the same suggestions of course regarding the drug alternatives to Eligard and Zytiga, and also radiation. I will be discussing these with my two urologists, and oncologist on 8/7. Glad that you are experiencing less side effects, and improvement with the changes that you made. Thanks again, greatly appreciated.

REPLY
Please sign in or register to post a reply.