pjoshea13 in reply to CERICWIN

By castrate, I meant <50 ng/dL. I suppose I should aim lower. I'm still intact, but with some atrophy, of course.

Good luck with the higher Xtandi dose.

-Patrick

pjoshea13 in reply to Geoff-H

I must have read hundreds of study papers that open with a discussion of ADT; its initial success in most men, followed by failure in 18-24 months in most cases.  The first paragraph of such papers started to read like boilerplate text. 

About 11 years ago, I read a paper where the author hypothesized that testosterone [T] might reverse ADT resistance.   His idea was that T would select for cells that would respond to ADT, & that a man might survive many years by cycling back & forth.  As I recall, it was published in a lesser known journal & I doubt that many noticed it.

I was ~57 then, & trying to figure out how to survive the next 25 years (LOL), so found the idea intriguing.  A common response to ADT is for for PCa cells to create more copies of the androgen receptor [AR].  Another is for AR to gain function - essentially, multiple copies of transcription specs - aka AR amplification.  A third response involved AR mutations.

I wondered what the optimal time would be to switch from ADT to T.  Seemed to me that AR mutations were to be avoided, & waiting for ADT failure might not be a good idea.

In looking at intermittent ADT IADT], I came across statements indicating that the ADT phase had to be about 12 months.  Shorter periods lead to a rapid return of PSA.  Dr Myers has an interesting string of vblog posts on durable remission & he mentioned that one can only do IADT 2-3 times before CRPC occurs, so the idea is to make the off-phase as long as possible.  Two years?  Three?  

I didn't like the idea of CRPC at all, so decided that 12 months of ADT was too long.

Samuel Denmeade at Johns Hopkins has written about rapid cycling, which he now calls "bipolar androgen therapy" [BAT].  Instead of stepping through his papers, lets cut to the pilot study paper of last year [1].

"16 asymptomatic CRPC patients with low to moderate metastatic burden were treated with testosterone cypionate (400 mg intramuscular; day 1 of 28) and etoposide (100 mg oral daily; days 1 to 14 of 28)."

"No patient developed worsening pain due to prostate cancer, nor were there any other skeletal events or evidence of worsening urinary obstruction. Furthermore, with seven patients exhibiting PSA declines, the study met the primary endpoint of at least three subjects with PSA declines. The PSA declines observed in this study are particularly remarkable because PSA is an androgen-stimulated gene product. BAT also produced objective radiographic responses in 50% of patients with RECIST-evaluable disease. Finally, post hoc analysis showed that 10 of 10 (100%) of men treated with BAT responded to second-line therapies after BAT, with 3 subjects responding to an agent on which they had previously progressed. These data suggest that BAT may have the potential to reverse resistance to androgen-ablative therapies, potentially resensitizing men to drugs to which their cancer had become resistant."

Frankly, I'm surprised that the results were that good, considering that these were CRPC men.

I can envision some kind of 'restart' T intervention during ADT, where cells are resensitized, pushing CRPC further into the future.

A note on the T dose: "testosterone cypionate (400 mg intramuscular; day 1 of 28)".

I use 80 mg weekly when I am in my T phase.  My T was above 1,000 ng/dL on day 8 (just before the next shot), the one time I tested, so I know the stuff lingers.  The study:

"dose and formulation produce supraphysiologic testosterone levels (>1500 ng/dl) within the first few days after injection, with a subsequent decline to high-normal testosterone levels after 2 weeks, and a return to near-castrate testosterone levels by 28 days"

-Patrick

[1]  ncbi.nlm.nih.gov/pmc/articl...

Hidden in reply to pjoshea13

I agree. Sounds right. Looks good. Are we nuts?

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Hidden in reply to pjoshea13

How did you get your doctor to go along and prescribe these medications?

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pjoshea13 in reply to Hidden

Slowly, non-confrontational, & chatting about the studies over time.

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Hidden in reply to pjoshea13

Making friend huh.

The old fashioned way.

Oncologist?

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jonnycrouch in reply to pjoshea13

Hows it working for you

john

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Hidden in reply to legsdickson

My father died of prostate cancer, but had few symptoms until shortly before his death. (He was being treated however.) How are you tracking the progress of your disease?

I do agree that your regimen is more "homegrown" in that it requires no Rx from a physician.

jonnycrouch in reply to legsdickson

Hi how is your protocol progressing are you keeping the cancer at bay- you might want to look at Daniel Goldstones website cheers John

jonnycrouch in reply to legsdickson

Hi how is your protocol going you might want to look at Daniel Goldstones website cheers John