Here's a long overdue update but I think pertinent to this discussion...
Had RP Surgery July 2021, pre-surgery PSA of 15.6, post surgery PSA 6.8. Due to the high post PSA I was put on Androgen Deprivation Therapy (ADT) in October thus allowing three months of post-surgery healing. My ADT consists of two meds, Orgovyx (Relugolix) and Xtandi (Enzalutamide). One thing to be aware of is these two meds are extremely expensive so check on your insurance before signing up for these. This therapy generally lasts about two years and depends on there being any remaining cells which may have become castrate-resistant prostate cancer (CRPC). At that point other more serious treatments such as chemotherapy would have to be started.
Orgovyx (1 pill taken once a day) is used to virtually eliminate testosterone production from the testicles. I can say it works very well and my "T" level dropped from 575 to a below castrate level (i.e.<50) within a few days.
Xtandi(4 pills taken once a day) is used as an Androgen Receptor Blocker and keeps any remaining cancer cells from being able to accept even the small amounts of testosterone remaining, that being the small amount still being produce by the adrenal glands.
The combination of these two medications essentially "starves/kills" some of the remaining cancer cells and puts the rest into remission. After being on this therapy for six weeks my PSA was 0.04 which is considered "undetectable" and my "T" level remained low at 24.
The side effects have been a lot of hot flashes, not so noticeable at daytime, but enough to wake me up several times at night, which makes it difficult for me to get a really good quality sleep. Add to that zero libido, but given that all nerves were removed with the prostate that is, unfortunately, kind of a non-issue now. There has been some (30%) testicle shrinkage and some minor weight gain. All in all not so bad as my energy levels and moods have not been affected at all.
My incontinence level has really improved and I am now using one Male Guard pad a day which is generally considered "continent" in most Urology circles. I will need to have a two month course of Salvage Radiation Therapy and the start of that is now up to me. The radiation will permanently "freeze" my level of incontinence once I start it so once I am "happy" with what I have I will start. The only limiting factor is I have to start the radiation not more than nine months after surgery.
One final bit of good news is that in December the LU-177-PSMA cancer-killing treatment has been approved by the FDA. It's so new that it's not readily available yet but it is a promising post-ADT treatment. From what I understand not quite a silver bullet but still a significant advancement.
