G’day comrades
I am reporting that I have ended for now my experiment of one with bipolar androgen therapy (BAT). I have tried to report in detail my experiences and you will find those reports in my profile. The last report was:
healthunlocked.com/advanced...
Basically, over 3 years ago my ADT (Zolodex) failed and I started bicalutamide which failed after 12 months and then started BAT. Bat failed at 8 months and rechallenge with bicalutamide failed after 6 months. Then repeated and BAT failed at 3 months and rechallenge failed at 3 months. Tried another repeat but BAT saw a significant rise in PSA to over my self imposed limit. Rechallenge should bring it down temporarily. The repeats showed reductions in the time to failure of both BAT and antiandrogen phases and greater volatility in PSA results. I do a Ga68 PSMA scan in about a month to compare with the one I did 3 years ago which showed 2 small mets at distant lymph nodes. I will report on the new scan.
End result: extended the usefulness of bicalutamide from 1 year to 3 years and ending at about the same PSA as I started. An OK result but at the low end of responses generally seen so far in limited trials. My next scan will tell the final story.
For those thinking about BAT I recommend the following 2 summaries of what has been learnt up to 2018.
Bipolar Androgen Therapy: progress and future directions
Michael Schweizer
oncology.medicinematters.co...
Bat in the treatment of prostate cancer
Sam Denmeade
hematologyandoncology.net/a...
Note Shweizer’s conclusion: “enthusiasm should be tempered and providers should be discouraged from rushing to incorporate BAT into clinical practice.”
Some conclusions may be drawn.
Firstly BAT is safe but note that so far recipients have been carefully chosen. In particular, symptom free. There is a danger of pain flare if there is existing PCa pain. The evidence is mixed. Early experiments reported pain flare in some, pain alleviation in others. The Johns Hopkins (JH) trials excluded anyone with PCa pain but admitted a few with what were thought to be arthritic pain at first but had a pain flare and it was concluded they had PCa pain. Pain lasted up to a week. Some of these opted to continue with BAT and there was no pain after the 2nd shot of T. Perhaps it is a one-off phenomenon. I think men with pain or extensive bone mets should be careful. The JH trials do not show any abnormal spikes in PSA. The worst result is that PSA progression continues at the same rate as before the shot of T.
There is great variability in response. I concluded that the best, cheapest and most accurate way to find out how I responded was to just do it and be ready to bail if things go wrong. You will be back to castrate levels in a month.
Note: Never take a PSA test in the first month after the first shot of T – completely unreliable. Take the 2nd shot and do PSA a month after that. In the event of failure in the BAT phase, rechallenge with the antiandrogen. It will most likely bring down PSA.
It is not mentioned in the research but sudden supraphysiological levels of T produce a spike in estradiol (E2). It reduces as T reduces and gets to an acceptable level after a month, when T is almost castrate. The E2 effect is well known to weightlifters and body builders who use T. Because a PCa patient will always be on some form of ADT during BAT, E2 is not generally a problem. But the spike after the T shot may be. For body builders it is usually managed with Arimidex. As substitute I tried a number of over the counter aromatose inhibitors for 2-3 weeks each month but their effect on E2 was exactly zero. They were our old friends diindolymethane (DIM), indole 3 carbinol (I3C) as well as chrysin and luteolin. All taken with bioperine to assist absorption.
The JH trials show that BAT re sensitises PCa to enzalutamide (Enza) and abiraterone (Abi). My experience is that it does likewise for bicalutamide. When I become resistant to a 2nd generation antiandrogen I will certainly consider reusing BAT. By then we will know more about it.
It is important that genuinely supraphysiological levels of T are achieved. Results with physiological levels are not great. As yet there are no reliable reports on continuous supraphysiological T.
JH did a small trial of BAT alongside ADT alone, starting BAT 6 months after first starting ADT, with good results but they decided to concentrate on BAT after Enza and Abi at first.
Because one of the modes of action (there are about 8) is double strand DNA breakage/ damage, combining BAT with PARP and checkpoint inhibitors is another line of enquiry.
