Urologist said I could stop Orgovyx. Your thoughts?

Posted by johnny8924 @johnny8924, 13 hours ago

Age 73, in very good health. Diagnosed with Gleason 9, August 2024. Been taking Orgovyx since then, Not quite 20 months. Completed 28 sessions of IMRT April 2025. Latest lab results a few weeks ago: PSA < .04, testosterone < 1. My urologist said I could go off Orgovyx when my medication runs out in 15 days. I’m somewhat hesitant to do so because who knows how my PSA and testosterone levels will be affected. Thanks for any feedback, thoughts, etc.

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jeff Marchi | @jeffmarc | 11 hours ago

A year of undetectable PSA is a good time to stop ADT to see what will happen. I know people with Gleason nine that have gone many years after stopping. I know others that have only been able to go a year or nine months. You need to find out how successful the treatment was.

You can always go back on the drugs.

jim18 | @jim18 | 10 hours ago

Usually, testosterone will increase 2-3 months after stopping Orgovyx. How much is highly variable. Unlikely to be to former levels. In the Orgovyx trials just under half of subjects age 65+ recovered testosterone to 280 or higher. (Under 65 this level of recovery was about 80%). As long as you have a prostate a PSA increase will occur with the testosterone increase. Should have both tested together after you go off Orgovyx. If your testosterone recovers with no RP your Dr. will probably consider a PSA of 0.5 okay (question to ask). If it goes up to 2 that will be biochemical reoccurrence and indicate further treatment required. If it is rising past the first bounce due to the removal of ADT then should ask about going back on ADT.

northoftheborder | @northoftheborder | 4 hours ago

Unfortunately, there's no risk-free choice: if you stay on ADT longer, you reduce your risk of cancer recurrence, but increase your risk of heart disease, bone-density loss, type-2 diabetes, and other conditions.

Back around 2012–13, a pair of studies came out, trying to determine when the ADT overall-survival costs outweighed the benefits. PR.7 suggested that after a while "ADT holidays" were beneficial for non-metastatic prostate cancer, but SWOG couldn't make the same determination for metastatic (outcomes for overall survival were slightly worse when patients took holidays).

Now that we have ARSIs like Abiraterone and the -lutamides, researchers are taking a new look to see if metastatic patients can take a holiday from ADT but stay on the ARSI.

I'm monitoring the big LIBERTAS trial, which is specifically for my situation, people with metastatic castrate-sensitive prostate cancer who have responded well to ADT+Apalutamide (Erleada).

chippydoo | @chippydoo | 4 hours ago

Heck yeah. You can always go back on if numbers start climbing. In the mean time enjoy being ADT free. I started feeling better after 3 weeks. Gleason 9 grade 5, 6 months undetectable here.

brianjarvis | @brianjarvis | 2 hours ago

As long as you’re still on ADT, your PSA is still being artificially suppressed; you’ll never know if your treatments have been successful until you stop the ADT.

My medical oncologist compared hormone therapy to training wheels on a bicycle - at some point you have to take off the training wheels and see if you can ride without them.

See if you can ride without them…….. (but get PSA tests regularly).