Cyclic Bat

[kaptank]

Cyclic BAT

G’day comrades.

Some of us have been following the development of Bipolar Androgen Therapies (BAT), sometimes in combination with other new treatments, sometimes as a serial treatment. Common or garden variety BAT starts when antiandrogen treatment (enza, abi, or in my case bialutamide) fails, then stop taking the antiandrogen but keep up with primary ADT, then every month take an intramuscular dose of T, continue until PSA is back in a rising trend, then rechallenge with the previously failed antiandrogen. Responses vary but an average rule of thumb is that this will about double the time the antiandrogen works. Both Patrick and I have asked whether this is repeatable and under what conditions. We have both come to a conclusion that the sooner one starts the better (perhaps even along with the initial primary ADT) and that is better to regularly cycle the treatments (BAT and antiandrogen) rather than continue each of them to failure. Eg in my case I now take bicalutamide for 2 months, stop for a month and then take my BAT dose and restart the bical about 2 weeks later, rinse and repeat. I don’t currently have enough data to say this cyclic version works long term but all up I have extended the use of bical from 1 year failure to about another 3 years using the old style BAT and more recently my cyclic version. PSA bounces around a bit but has generally cycled from 1 to 5. I take a PSMA scan shortly that will tell me more. However the idea that BAT may be able to be cycled for relatively long periods of time seems to be gaining currency among the early proponents of BAT such as the groups around Johns Hopkins and Sam Denmeade. These are 2 reports of that rethinking.

cdmrp.army.mil/pcrp/researc...

atm.amegroups.com/article/v...

[Tall_Allen]

"I have extended the use of bical from 1 year failure to about another 3 years using the old style BAT and more recently my cyclic version."

Bical failed after just one year? That is very short duration.,

[kaptank in reply to Tall_Allen]

Yes, I thought so too but my onc said it wasn't unusual. PSA was in a clear uptrend.

[Tall_Allen in reply to kaptank]

Cancer learns to feed on bicalutamide. You would be better off alternating with a stronger hormonal agent (which is what they do at JH).

[kaptank in reply to Tall_Allen]

Thanks TA. I will discuss with my onc. My initial response to bical was not great, about a 50% drop after 4-5 months, then a steady climb then steeper with a well confirmed uptrend at 12 months. The first response to a rechallenge was interesting: a quick 80% drop then flatline for a few months, then rising to uptrend. I have concluded that I may have been partially resistant to bical from the start before I was exposed to it. I think we are only starting to learn what may be the best combination/sequence for supra T/ antiandrogen. It probably depends on individual responses and the specific bio molecular processes in each case. It may be that for some, continuous supra T is effective, for others, BAT. But we don't have the means to distinguish them (except by just doing it).

[Tall_Allen in reply to kaptank]

I doubt supraT without BAT is effective for anyone but a few rare birds. It has never been shown to be effective. See "Why can't we just give continuous high doses of testosterone?" in the article linked:

prostatecancer.news/2016/09...

[kaptank in reply to Tall_Allen]

Thanks. A good summary of where we were in 2016. In agree that continuous supra T may be risky, mainly because we just don't know, not enough experience of it.

[Tall_Allen in reply to kaptank]

I keep it updated. Unfortunately, it makes about half the men worse, and we still don't know which men. It may reverse Xtandi resistance for a while, but will that translate into longer survival? We have no idea. It's interesting, but still a lot of work to do. Meanwhile, it should only be done in carefully watched clinical trials.

[LearnAll]

Kaptank...How do you decide when to stop Bicalutamide and when to start it again ? What parameters you use for cycle start and cycle end ? Please provide details.

[kaptank in reply to LearnAll]

A trend of 3 rising PSA taken monthly. Or 2 if a large rise (eg double, or above my self imposed bailout point of 5.) Generally I try to keep in a range of 0-5. That is with old style BAT. With cyclic, 2months of bical, then stop, nothing for a month then 1 shot of T, restart bical 2 weeks later. I'm still evaluating the efficacy of this,

[Fairwind]

When I started talking about BAT to my doctors, they all lost interest...So I thought I'd give the DIY method a try but Customs seized my shipment of testosterone..No BAT for me...

[kaptank in reply to Fairwind]

I am sorry to hear that. Generally national border police are quick to jump on steroids. Internal state borders are pretty porous so the task is to find a producer lab within your own country using internal mail. That grey market for bodybuilders is a bit risky, most are scams/inferior product and you need some advice from experienced body builders. Reliable suppliers are often discussed on chatrooms but you need to be alert. Obviously, if you can find a doc willing to write a scrip, cherish that doc. There are some in the US. Here in Australia any doc who writes a scrip for a PCa patient gets an inquiry from authorities - there is a national database of prescriptions.

[pjoshea13 in reply to Fairwind]

Was this U.S. Customs?

My understanding is that you can respond to them by explaining that the T is for your personal use & thay will be obliged to send it on to you.

-Patrick

[Hidden in reply to Fairwind]

In the US there are loads of men's health clinics that do TRT. I've gone to two clinics and getting scripts for test is very easy. Docs at both clinics were not under the old assumption that test is like gas for PCa.

So, I came up with an SPT/BAT program and take 400mg/week of cyp.

[nobaday]

Kaptank

Thank you SO MUCH for keeping us updated on BAT. I have followed BAT posts on this site for 3 years and also video presentations by Sam Denmeade, Michael Schweizer ( current clinical trial on Olaparib and testosterone) and Bob Liebowitz.

My PSA has only gone up from <0.008 to 0.068 yesterday after nearly 3 years on Abiraterone but MRI and CT show spine Mets at C4 and T9 to T12 are growing again. So Abiraterone failing/ failed.

I have some pain around T9 ( where I had spinal compression surgery Nov 2017) which I currently control by Advil: Tylenol.

I have options to do chemo and/or some radiation by SOC.

I am down to get a PSMA scan in Jan 2021 which could open more options if I am PSMA avid.

My other option outside SOC is supraphysic T.

I think this could control/ keep in check/ hopefully kill any prostate cells that are now growing in a zero T , ADT controlled environment.

The one concern I have of doing this basically on my own is if there is a tumour flare on 400mg T Cypionate injection that could cause spinal compression.

All trials involving high T have typically made symptomatic CRPC men ineligible.

[kaptank in reply to nobaday]

Yes, there is not much data on symptomatic men. The first shot of T causes a PSA flare but there is no evidence that it is a PCa flare. The most likely hypothesis is that the first exposure to supra T causes significant PCa cell death, releasing their PSA. There are anecdotal reports of supra T temporarily increasing bone pain but others of it decreasing pain. Some of the early BAT trials included patients with apparent osteo pain that later turned out to be PCa bone pain. Some of them experienced increased pain that subsided when the T went down (about a week or so). Some of them elected to stay in the trial and subsequent T shots did not cause increased pain. We just don't know but I think there is a risk there that the T may cause inflamation at Pca sites.

[nobaday]

Yes I read about the ‘ osteo pain’ My thought would be to have NSAIDS on hand. When I used to go on 8h plus mountain hikes I would take Advil before I went, as do some marathon runners I believe.

One guy on this site reported tumour flare from Lu177 on a trip to Germany ( not Heidelburg where apparently they are familiar and control this side affect) . The flare caused him spinal compression. As you said in the ‘ osteo pain cases, the patients seemed to get through the pain .

Presumably symptomatic CRPC men are made ineligible now for clinical trials with high T so that this side affect/ withdrawal from the trial does not affect the clinical trial data??!

[noahware in reply to nobaday]

I suspect they are also ineligible simply because they docs don't want the higher risk of inflicting severe pain as a short term response, regardless of any (good or bad) longer term response regarding PSA or PC progression.

As I recall, Denmeade mentioned that for a (very) few men, the pain appeared within mere hours of getting the T shot, which made him doubt very much that the pain was related to a flare of PC itself. He suspected some kind of inflammatory response. But even if you rule out the immediate experience of pain as tumor flare, I don't think you can rule out the possibility that the PC might be progressing.

[skateguy]

I have been living with metastasized prostate cancer for 10 years. This year my PSA has gone up dramatically (513 in 10/1/2020). I am symptomatic. First BAT injection 10/30/2020 being conducted outside any trial, as I do not qualify. Bone pain increased slightly (sacrum), nerves in my legs were affected and had numbness in my right heel. All this occurred slowly. There was no significant flare up. In fact, I was suspicious they gave me a placebo, haha. Lower spinal area became tender to the touch. Maybe from inflammation. Yesterday was the first day I noticed a reduction in bone pain and nerve issues. I'm expected to have 3 months of T and 3 months of enzalutamide. I will post a detailed BAT experience maybe six months from my first shot or if something dramatic happens.

[kaptank in reply to skateguy]

Thanks. I await with interest. The more info we put out there (good bad and indifferent) the better.We cannot expect to see full scale phase 3 trials any time soon.

[lewicki in reply to skateguy]

At this time what results and are you still doing BAT? Thank you.

[skateguy in reply to lewicki]

My oncologist thought that the testosterone shot made things worse for me. I did not see any difference and did not agree. However, my oncologist discontinued the treatment. In February, I went for my second round of radiation to my sacrum at the insistence of my oncologist. Just recently started Jevtana and looking forward to the FDA approving LU-177. Currently, I feel great and remain very active.

[lewicki in reply to skateguy]

Thanks for your reply. Are you on an ADT such as Lupron Also? What is the T dosage.

[skateguy in reply to lewicki]

Last quarterly Elligard shot was in January. I don't go by time, but instead, I go by condition, meaning I will not get another shot unless my T moves above undetectable.