I’m not sure if Patrick shared this article with us or not (most likely the answer is yes). But just in case here it is:
Bipolar Androgen Therapy for mPCA - Advanced Prostate...
Advanced Prostate Cancer
While I am not castrate resistant I will be taking a vacation after 18 months of ADT. Makes me nervous but the MD thinks it wise
Were you diagnosed as stage 4? Curious why he's taking you off HT.
Hi. Ya. Stage IV. My PSA is undectectable after these months so they feel it’s a safe move. We will monitor and Jump back on if PSA moves
Thank you for the information.
I recently transferred to the U of Minnesota clinic. I've been sliced and burned, but still have PC. I just reached the 18 month on ADT point and my oncologist also recommend a break and a recheck in 3 months, which I agreed to try.
Another adventure in healthcare!
It's a bit difficult for this lay person to figure out what is going on here. Except that it seems to work. It seems to be flood the tumor/lesions with far, far more food than they can handle followed by starvation. This one-two punching wears down the tumor's vitality knocking it back.
Am I totally misconstruing this?
From wpopomaronis in the posts. Nice slides
Thanks!! I understand it a lot better now. I'm on my first round of docetaxel so I would be excluded from this anyway.
regarding the diagram in the PDF:
The Androgen Receptor is more like a shortstop (with a glove) rather than just the glove. Once the shortstop catches the ball, he runs to second base (the nucleus) where he does something (expresses proteins) and then throws the ball to first (and the proteins do something else). The pair (androgen, androgen receptor) are the signalling part of the story, but the signal causes other things to happen, and that is why the signal is important. If the signal caused nothing to happen, no one would care about the signal.
Misconstruing, yes, a little. The purposes of BAT it to resensitize the cancer to enzalutimide. Since the conceptual reason that enza (hormone therapy) fails is the ARv7 variant (that has no hormone binding domain), BAT is aimed at weakening the ARv7 population, rather than being aimed at (weakening) the across-the-board prostate cancer population, for which population testosterone IS considered by some as "food", ie a growth promoter.
"It seems to work" is the key take-away, in some people, and for some time.
The neuroendocrine variation is also a reason that hormone therapy could fail, and is becoming more prevalent, as a component, after 2nd line (abi/enza) treatment. Snuffy mentions this around 3:25. I meant o post the "Grand Rounds" video he mentions, where he goes into this more.
This is my understanding at least. I do hear people say that the AR can interfere with "licensing" during the duplication of the cell nucleus (Isaacs is the person, at Johns Hopkins), but I don't undertand that mechanism at all, since gene expression is so different from cell replication.
I will be flying solo--off my Main ADT drugs at 22 months, of undetectable PSA----yes it is a bit scary---but the off chance possibility that The Pca cells, that have not been killed, and have been worn down to dirty old men, and not capable of much harm, and that getting my old self back for a time--is worth the try----the reason Docs. want to do this at about no longer than 18 months, is to prevent Pca cells from becoming Castrate Resistant----so choosing a maximum PSA number you are willing to live with--is important---if reaching that number be prepared to go back on ADT for awhile---to then come off again---trying to continue to wear out cells that become active, and are harmful---by putting them back to sleep again, while killing some more. The more months of undetectability of PSA, the better the odds, of being able to go a long time off ADT, and once in awhile we get durable remissions.
I will easily settle for a durable remission---I think it is defined as lasting, at least 10 years