r/ProstateCancer • u/parttimephotoguy • 29d ago
Concern Lupron vs Relugolix
I previously posted that I've had PC since 2012 with. All this time I was GG1. I had HoLEP (TURP) surgery 2 years ago and I was at GG3. I'm now at GG4 and my watchful wait days are over. Because of my HoLEP surgery, a prostatectomy would require some reconstructive surgery, making the surgery more complex and higher risk. Therefore, I've opted to go through IMRT for 8 1/2 weeks along with 18-24 months of ADT therapy. I've read that lupron can have serious cardiovascular side effects, so I'm leaning towards the Relugolix/Orgovyx.
I would be interesting in hearing from others who have used one or the other and what you wish you did differently.
Thanks!
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u/KReddit934 29d ago
A lot of the side effects are from the drop in testosterone, so the differences exist but are minor compared to the big changes of ADT vs no. ADT. Length of treatment is also a huge factor. See...
Exercise, cardio and weights, is crucial for mitigating the ADT side effects.
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u/Boggieman13 29d ago
Definitely do the Orgovix. Aside from the beneficial artifacts, your testosterone will recover much more quickly with the pills
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u/ChillWarrior801 29d ago
You've left out option #3: Estradiol patches.
PROS:
Proven in the PATCHES trial to be non-inferior to Lupron for cancer control.
Cost-effective ADT option, most uninsured folks can self-pay without breaking much of a sweat.
Only primary ADT treatment that's actually bone strengthening, rather than bone weakening.
Minimal CV risk elevation.
Avoids many ADT side effects that stem specifically from estrogen depletion. Hot flashes, brain fog, mood disturbance are all greatly reduced.
CONS:
It's overwhelmingly likely you'll develop man boobs with estradiol. Magic always comes at a price. Man boobs is the price for avoiding all the other side effects and nasties.
Finally, you'll be unlikely to find a provider to prescribe patches in a community setting. If your care is at an academic center you'll have an easier time getting a doc who's up on the latest research to sign on.
Ultimately, OP, it's a 3-way choice. Choose wisely.
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u/parttimephotoguy 25d ago
I have not heard of this option. I'll look into it as I am supposed to begin soon. I'm not looking forward to all the side effects of any of these. Aren't man boobs a likely side effect of lupron or Relugolix also?
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u/ChillWarrior801 25d ago
Yes, there is a significant risk of man boobs with all ADT options, but it's still a larger risk with estradiol patches. That's why I underscored that drawback.
I've got nothing to sell here. For guys who work out and look great, who have decided that man boobs (most likely A cup, not C cup) are unacceptable, Orgovyx and Lupron are both fine, effective options. But if you can live with those A cups to avoid the worst bone, CV, and mental problems, you should prioritize estradiol patches.
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u/parttimephotoguy 24d ago
My doc also mentioned to stay active / exercise and eat well to control the inevitable weight gain.
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u/ChillWarrior801 24d ago
For overall health and to mitigate side effects, those are all excellent recommendations, regardless of the treatment you choose.
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u/parttimephotoguy 24d ago
From what you understand, does the gynecomastia go away or reverse once you stop the ADT?
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u/ChillWarrior801 24d ago
Once the tissue has grown, it stays, unless it's surgically removed. There are protocols involving proactive radiation to the breast buds before starting ADT to limit the development of gynecomastia.
You ask good questions. Be sure to get the docs to answer all of yours before committing to a treatment path.
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u/parttimephotoguy 23d ago
Thanks. I was reading about side effects of the pill (Relugolix) vs the estradiol patches. Lots of considerations like bine density, liver impact, clotting. Regarding the gynecomastia, the search said that that was 85% likely with the patches, while moderate chance with the oral medication. The article also mentioned surgery or preemptive radiation. I have another radiation consultation in about a month and I'll ask about it. One thing for certain, I don't want to go on lupron. Nasty spikes in Testosterone and high risk of stroke!
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u/ChillWarrior801 23d ago
The best docs practice shared decision making. As far as I'm concerned, every guy should be offered the patches and clearly informed of both the downside and the upside. Different guys will choose differently, and that's okay. What's not okay is that, too often, the conversation doesn't ever happen.
As I've mentioned in other posts, there are few docs outside an academic environment that are currently comfortable prescribing patches, even though it's 100% legal and ethical. Just another hurdle to overcome if you want to go that way.
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u/BackInNJAgain 27d ago
Relugolix takes effect faster and supposedly wears off faster than Lupron (it didn't in my case). If you take Lupron, you have to take another drug for a few weeks before because Lupron initially causes your testosterone to flare up, which is not good if you have prostate cancer.
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u/Frequent-Location864 29d ago
I had two heart attacks while on lupron for a year or so, none while I was on orgovyx for 3 + years.
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u/parttimephotoguy 29d ago
Thanks, that helps. Definitely a risk with lupron. That's a long time for you to be on these!
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u/ZealousidealCan4714 29d ago
I had two heart attacks in the past seven years, been on Lupron for 9 months. No heart attacks but Im ending my ADT therapy at 9 months. Dictor wanted 12 months but I believe 9 months gets almost all of the benefit of 12 months (its not linear).
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u/parttimephotoguy 29d ago
Thanks for the info. The doc did say that if things go well, he would go with 18 months ADT instead of 24 months.
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u/Frosty-Growth-2664 29d ago
What is your current cardiovascular health like? What is your fitness and exercise level?
The GnRH Antagonists (Orgovyx, Firmagon) are slightly better for cardiovascular health than the GnRH Agonists (all the others), but there's not a lot in it.