Got #2 T shot yesterday. PSA went from 2.63 last month to 9.38 yesterday. Dr. is saying to stay on the BAT one more month and if PSA is still rising, then will stop this and go onto chemo, probably. Very disappointed - really wanted the BAT to work - was only on Zytiga for 5 months before PSA started rising.
BAT (Bipolar Androgen Therapy) - Advanced Prostate...
You probably have the AR-V7 gene splice abnormality. High T injections, where they take your T to Supra High Levels for about 3 months---400 mgs per injection, can resensitize the use of Zytiga, in about 30% of the men. Chemo can do it also--but Chemo is not on my greatest hits list. Chemo also works to sensitize about 30% of the time. You probably would need to be Gene Mapped, IMO, if you have not already--many here use Foundation One.
I have BRCA2 gene mutation.
Consider a clinical trial:
Patients with BRCA2 could have a good response to Olaparib or similar drugs.
There are clinical trials for these drugs, one of them is:
How often do you test PSA? When I was doing BAT, I tested weekly. After the testosterone injection, PSA would shoot up. But then it would fall VERY rapidly, sometimes 40% in a single week.
If you are relying on a single test there is no way to tell where you are on that curve. I stayed on BAT until the PSA didn't return to near baseline levels. I could only tell that something had changed because I was testing so often.
A PSA test costs $12.95 plus a blood draw fee, typically $8. You can order them yourself.
I'm getting a test monthly .... interesting ... thanks.
The protocol I use is to take PSA when T is at the low point, before the next injection. I take monthly PSA but one should never take a PSA in the month after the first T shot. Too many deaths from cardiac arrest. You get seriously scary but entirely irrelevant results. Get PSA on second and third month. If its below the starting point (before the first injection) or if it is trending down (even if above the start) then continue, otherwise stop and rechallenge with Zytiga. When its trending up (say 2 or 3 rises in a row), stop. Rechallenge. That is basically the Johns Hopkins protocol. It takes 3 shots and 2 PSA (plus the starting PSA) to find out if you are responsive. It can be nerve wracking especially if you take PSA in the first month. Keep us informed as to how it goes. Even if it fails, rechallenge with Zytiga.
I think "Too many deaths from cardiac arrest" is rather wildly over the top. Yes, the PSA rises, sometimes a lot. That is part of BAT. If that bothers you, don't look, or reconsider whether you really want to be on BAT.
One of my doctors told me, when I was expressing concern about a much earlier, much smaller rise in PSA, "Remember, it is just a number." She's right. PSA is a proxy, it is NOT cancer. Other things like inflammation and ejaculation can raise it. Treat the cancer, not the PSA. The PSA is a useful tool, nothing more or less.
My nadir PSA values NEVER coincided with my lowest T values. There are delays and lags.
Yes, sorry for the over the top dark humour. That first month PSA is a real killa.
You are absolutely right about PSA. We are looking for trends. There is a theory that the first month PSA spike is due to the supra T killing large numbers of cells that are unadapted to the sudden spike in T, releasing PSA as they go to cell hell.
Your point about the meaning of the first month PSA spike is excellent. We don't know one way or another, but it is possible that the PSA spike is somehow related to many cancer cells dying. PSA is strongly correlated with inflammation, and it's certainly plausible that killing a fraction of the prostate would produce some inflammation.
So you are currently participating in BAT trial? How did you get hooked up with that? We read about it sometime back. My urologist is not a fan and doesn't believe in non-FDA approved protocols. I have been on Xtandi for over a year and my numbers are suddenly increasing. My doc says the only options left are Provenge and chemo. Not at all interested in chemo. Have an appointment with an oncologist and genetic counselor in a couple weeks. Would like to hear how things are going with you.
Mine is a trial of one. I just did it. Got my T from the underground suppliers to the body building fraternity. My oncologist disapproves but will still talk to me. My profile has my detailed reports. The end result of my first experiment was it extended the use of bicalutamide by over a year with a final PSA one third of the starting baseline. At the moment I am seeing if the trick can be repeated. Its too early to have anything to report but when I do, HU will be the first to know, good or bad.
You are amazing, what a place we have, share our experiences, and you revealed a BAT way.
Who is your doc? Will like to consult with him, I'm treated by Dana-Farber, yeah, I know one of the best cancer orgs in the world. But, they are so standard of care (SOC) way, I'm not impressed.
I'm currently on Lupron/Zytiga, the docs say I'm doing great because the creepy crabs are hormone sensitive - "AT THE MOMENT"...
If your question is what Dr do I have, it is Dr. Oliver Sartor at Tulane Medical in New Orleans. I have been with him since I was diagnosed in the spring of 2012. He is open to new conventions and I have utmost faith in him and his team. He currently has about 35 patients on the BAT program. Some are showing excellent results, and some not so much. I'm really hoping that my PSA goes down next month ... will know on the 28th of May .....
I am also a patient of Dr. Sartor, just got back from seeing him on Tuesday. I was fortunate to become a patient of his when Snuffy retired. Snuffy had excellent things to say about him.
I’ve been on Xtandi for over four and a half years now, BAT is something we discussed if/when the Xtandi fails. Like you, chemo would be next (Jevtana) in an effort to resensitize, I am not a fan of chemo after going through 6 rounds of taxotere three and a half years ago. However I’ve read that Jevtana is not as harsh and that Sartor administers it in a way to minimize SE’s. He is very mindful of the SE’s of treatment and patient QOL, which I really like about him.
Good luck, keep us posted on your treatment and results.