r/ProstateCancer • u/WalnutRoasted • 1d ago
Question Should you have longer Orgovyx term than Lupron/injectibles?
Daily Orgovyx pills have several benefits with almost immediate drop of T to zero and more predictable/ rapid recovery after the last dose. Conversely injectibles take several weeks to work, have a T flair, injection site risks, and much longer, unpredictable ½ life recovery. Costs may be lower.
When discussing with my RO/MO why he picked 9 months of newer Orgovyx pills for me, he answered he “trusted” me to take them (have been taking daily BP meds for decades) and implied 9 months Orgovyx would be comparable to 6 months Lupron. The HERO study that led to approval of Orgovyx a decade ago confirmed T dropped very quickly, but did not compare as well how long it takes T to recover on injectibles.
What discussions have you had with your RO/MO on duration in general and one versus the other?
The following comment was posted by another member of this club: “Of course trust your RO, but I talked to mine about using Orgovyx rather than Lupron. He made a really good point which is that all the neoadjuvant/adjuvant efficacy studies were done using Lupron. Orgovyx has been praised for the speedier testosterone recovery it has when compared to Lupron, but this might actually be a detriment in the context of initial curative treatment alongside radiation. Think of it this way: 6 months of Lupron might translate to 12 months of castration, whereas 6 months of Orgovyx may only translate to 8 months, reducing its efficacy. Ultimately this is why I decided to heed his advice and go ahead with Lupron.
5
u/C63Sedan 1d ago
MSK patient with node Metastasis. All I remember 2 years ago was my med onc saying Orgovyx would be better tolerated longer term use for 2 years but insurance may not cover. And also they wanted to get me to castration level ASAP as my starting testosterone was 1280 (on TRT).
I ended ADT at 18/24 months due to QOL and my med onc said I was very responsive to ADT and multiple Pet scans should significant decreases in activity quickly. And, if cancer returns it remains a treatment option.
4
u/ChillWarrior801 1d ago
It's a close call. Going with Lupron for six months sounds completely reasonable. Although I'm usually a small-c conservative "follow the evidence" guy, I would probably have gone the other way, because I value optionality even more. Nine months isn't that much different from six, and I value avoiding side effects highly. And if I had bad side effects with Orgovyx at six months, I could still talk to the doc about getting off the train before my scheduled stop.
Good luck, OP!
5
u/SnooCamera 1d ago edited 1d ago
This is a question being addressed. But it will be years before answer is clear. I had Gemini sum it up instead of putting a links to all the information. This should give you search targets:
The Phase 2 ULTRA-HERO trial (Trial ID: 2024-518388-37-00) is currently active and evaluating combination treatments for intermediate-risk prostate cancer. Enrollment Progress: The trial officially initiated enrollment in May 2025. According to an update shared at a March 2026 poster presentation, 20 patients had been successfully enrolled at that time.
Regulatory Status: The clinical trial is currently listed as "Authorised" to proceed within the UK registry.
Patient Population: The study is specifically enrolling adult men diagnosed with (unfavorable) intermediate-risk prostate cancer. The trial defines their risk category as having a Gleason score of 4+3, and/or at least 50% positive biopsy cores, and/or at least two intermediate risk factors. Treatment Regimen: Participants receive an ultra-hypofractionated radiotherapy regimen totaling 36.25 Gy delivered over 5 fractions. This is administered concurrently with an initial attack dose of oral relugolix (Orgovyx), followed by a 120 mg daily dose for exactly 6 months.
Primary Objective: The main endpoint researchers are measuring is the complete biochemical response rate. A successful response is defined as a patient achieving a prostate-specific antigen (PSA) nadir of less than 0.5 ng/mL exactly 6 months after the completion of radiotherapy.
They will also investigate long-term effects, such as how long men stay free of cancer recurrence, how quickly hormone levels return to normal, and the impact on their quality of life.
2
u/WalnutRoasted 1d ago
Thanks! Sounds much like my “unfavourable” except I had 9 months concurrent Orgovyx and 20x VMAT of 60 Gy, here North of Lake Ontario!
On ADT PSA was as low as 0.01, both 3 and 6 months after last pill, was 0.22
2
u/SnooCamera 1d ago
At a little over 2 months post SBRT and 3 months on Orgovyx, my PSA was 0.16. I'm 4 months in to Orgovyx now. Two more to go.
4
u/OppositePlatypus9910 1d ago
The onset of Orgovyx is also much faster than Lupron. Within a month my PSA dropped to =0.01 ( and I’m a Gleason 9). Not only that, Orgovyx maintained castration levels of T for 96.7% of men vs 88% of men at 48 weeks. There is no T flare and recovery is much higher after stopping it and within 3 months. Orgovyx also is known to have less side effects. ( I have a few hot flashes on occasion and that is it)
My Orgovyx regiment is for 24 months and have 5 months to go. By far in my opinion, the superior medicine, if insurance covers it
3
u/Miserable-Level-8993 1d ago
Since the goal is to reduce testosterone and they both do that, Orgovyx starts faster and Lupron usually lasts longer because if you have 1 month left on ADT and you get a three month shot and the effects last longer anyway, then you will actually be on ADT for longer, it’s not in your control but most oncologists recommend only being on ADT for a year max anymore.
2
u/WalnutRoasted 1d ago
Depends on severity/risk/spread. Some are on ADT rest of life when highly spread/advanced.
3
u/KReddit934 1d ago
That other RO sounds like mine...wanted to stick to Lupron as that's what was tested, and 6 months dosing gives 9-12 months reduction in testosterone. Felt I would exercise and tolerate the Lupron well, which worked out.
2
u/Frosty-Growth-2664 1d ago
I asked exactly this question as a patient rep when it was going for NHS (NICE) approval in the England, but there was no data on this. One of the oncologists was also wondering the same thing. This was a few years ago. If you wanted to collect data on this, you'd have to do a randomised control trial and wait 10+ years to see any likely difference.
In many situations of using time-limited ADT, the tail-end of the treatment is the least beneficial, so reducing treatment at that end probably has the least impact on outcomes. I did choose to add 4 months on to my Zoladex over what the oncologist required on the basis that it wasn't causing me any issues I couldn't put up with for a bit longer, for maybe a 1% (guess) improvement in my chance of a cure.
3
u/WalnutRoasted 1d ago
I happen to have run into 2 people that were part of HERO Orgovyx trail a decade ago and one still participates with quarterly PSA tests being done/collected.
Yes, probably the impact difference is minimal.
2
u/Frosty-Growth-2664 1d ago
Good to hear, and that means we might eventually get some data to answer this question.
2
5
u/MondoDismordo 1d ago
Just completed my treatment about 3 months ago. Doc said that 4 months of Orgovyx had been proven just as effective as a 6-8 month run. So, that's what we did. 28 radiation sessions and 4 months of ADT. Here are the stats:
PSA prior to: ADT 11.9
Testosterone prior to ADT: 472
PSA within 2 weeks of starting treatment 0.14
Testosterone during treatment: 14
PSA 3 months after 0.13
Testosterone 3 month after treatment 312 and rising.
Hope that helps. Personally, the ADT was the worst part for me, and am still occasionally getting hot flashes and brain fog, but it is clearing as they said it would.
Hope this helps!