First visit after starting ADT

I started Adt December 10 with a shot of firmagon and started zytiga on December 12. PSA in December measured 4.8, testosterone was 408. My second dose of firmagon is scheduled for this Friday, January 7.

I think there will be some bloodwork (liver enzymes) and other tolerance tests. Three questions for those with adt experience:
1. What questions should I make sure to ask?
2. What tolerance or other tests should I make sure are run?
3. What outcomes in terms of results should I expect after 28 days (PSA level, testosterone level, liver enzymes, etc)?

Todd, I had two Firmagon shots together before starting IMRT. I started Orgovyx while getting the treatments. My Uro wanted a PSA test while still getting IMRT. My PSA was never really high just before starting the treatments. (1.99). My testosterone was never tested before, but during my last test it was only 25. My PSA only dropped to (1.20). My radiologist said that the current treatment would effect that reading. He is looking forward to the next test next month. I am also a GL-8. Just curious, have you decided which treatment you are going with, RA or surgery? The sooner the better with GL-8. At least that was what I was told. My best to you.
Jack

Todd, dont sweat too much about the temporary delay, the ADT will hold the beast in check.

I started on Firmagon. A month after my first shot my Testosterone dropped from 322 to 7. My PSA dropped from .08 to <.05 (limit of detection at MSKCC). Second shot, i had a pretty tough local reaction to the shot so i was switched to Lupron.
Triglycerides, which have always been a problem for me, went over a period of about 4 months, from 165, to 260, to 520 (Yikes). Numbers approximate, as i recall, but pretty close.

Best thing you can do is exercise every day, both cardio and resistance, watch your calorie intake and stay away from carbs. Do as i say, not as i did.

My firmagon experience was in 2012, it was almost a year after RALP and in preparation for salvage radiation. I had 2 shots, one caused a pretty intense local redness, swelling and tenderness but tolerable. Hot flashes , low energy, mood lability, short temper in the months around starting ADT. Mark Shanahan, a journalist, wrote a story and a podcast with his experiences. "Mr 80%" His story resembled how I felt.
I only had 2 doses of firmagon but my T ,which was normal prior, never recovered. It was 30-70 for the next 9 years with no additional ADT, my docs have no idea why?. Labs were stable, my lipids were already trending up and eventually I started a statin but no direct cause from ADT. I have stayed active but lost a concerning amount of muscle mass. My current T is less than 3. started back on ADT/eligard about 1 year ago because "insurance and policy demands it" even tho T was at 30. Xtandi was intolerable to me after 6 weeks d/t fatigue and mental fog, Zytiga much more tolerable tho. about 10 weeks in with Zytiga/prednisone. Psa is responding well. I am fairly accustomed mentally to the low T effects after nearly a decade of it but I worry about the muscle loss and my bones. Dexa scan pending. The low T is a life changer but its doable. Few people can understand how it affects a person but the guys on this site can empathize. I wish I would have weight trained more and kept up my workouts. Its much harder with no T. Keep a routine or start one if you can.
Keep us posted brother!

Cyclone,

My MO tracked both. The testosterone was <3. But PSA increased.

Not sure if I can draw a conclusion that cancer is castrate resistant after 1 month?

Thanks Jack.

For completeness, the PSA was 4.8 on the day of injection. It was 4.3 in October.

Thanks for the PSA update. Sorry I missed that read. Again, I wouldn’t get too concerned. Develop a trend and see what that tells you. You never assume refractory disease from one read. What did the MO say?