How long after starting BAT would you see a true PSA result?
BAT will artificially flare PSA to a degree before either dropping the PSA or the PSA continues to rise.
Does anybody have any info on this?
One month? two month?
is there any data anybody knows of?
Although it wasn't necessarily a BAT protocol, the reports by Bob Liebowitz (when he administered high-dose T) were that men varied widely in PSA response. One common and initially worrisome observation was that PSA might rise over 2, 3 or 4 monthly labs but then eventually stabilize.
So short answer: your mileage may vary. Needless to say, many MOs would see a multi-month progressive rise as a sure sign of PC progression, but that would not always be the case. Depends too on whether one still has a prostate or not!
Patients who had a consistent rise of PSA after three months of T injections stopped BAT if PSA was more than 25% higher than the baseline. They take men off BAT if there was radiographic or clinical progression while taking testosterone. This has to be very closely monitored as part of a clinical trial - about half the men had to be taken off it - it made them worse.
This article is updated with the latest data:
Taylor,
I believe that BAT might need to be tailored for some. The 28-day cycle was a big problem for me. I started in Oct 2018 & had leg pain a few months later. By July 2019, it was clear that I needed to be on a 2-month cycle. I think that the large dose of testosterone cypionate was slow to clear in my case, & that I had too few days at castrate level.
I would suggest that anyone experiencing a rise in PSA while on BAT, should lengthen the cycle. If one starts out on the 4-week protocol, I suppose that a good way would be to keep increasing by weekly increments until PSA trends down.
-Patrick
Four months of PSA being 0.03-0.04. Only treatment during this time is Estradiol patches 2 0.1mg changed twice weekly. One month after one injection of 400mg Testosterone cypionate, my PSA is 0.12 Testosterone is 834.81 and Estradiol is 329.10. Estradiol patches are continuing and now waiting for the Testosterone to return to castrate levels. At that point will see what the PSA is doing. As Patrick noted the 28 day Testosterone injection cycle may not be long enough to allow the Testosterone to return to castrate levels. (if it will) I guess it is up to the efficacy of the ADT (Estradiol in my case) on board to force the Testosterone back down.
Definitely a moving target
This is a great point. Testing T before the next shot would show this obviously, but then knowing how long you have been castrate is another thing.
The PSA should help to decide as well as what the Testosterone is doing
Estrogen is a great ADT. But it does not work quickly. So your cycling might be blunted relying on E2 alone.
Patrick, my MO won’t let me try SPT or a variation of BAT without a consultant giving an okay. So I am going to SCCA in Seattle this Tuesday and consulting Michael Schweitzer. ( He of the BAT trials). I am HS PC and my only disease on PSMA was 2Pelvic LNs that were treated with RT. My PSA continues to decline now 0.080 even as some T slowly tries to recover, now 130.
So it is a good time to do a personal trial of SPT for my severe hypogonadism. I want to do 4 weeks of high T (200mg/week for a month) and see what my PSA does. No ADT.
If it climbs significantly then I must have micro metastasis and will consider a slow cycling form of BAT. If PSA does not progress then I may just go on continuous TRT. “Life is what happens while you are busy making other plans.” 🙏🏻 Stay tuned
Will look forward to a report of your meeting. I corresponded with him until he said it was unlikely he would be able to prescribe BAT for me. (PSA <0.02, T<2.5, Eligard every 3 months, 2014 nano-iron MRI at Radboud showed metastases to para-aorta and common iliac lymph nodes).
You wrote: "If it climbs significantly".
Before I decided to try BAT, I was on a 3-month T / 3-month castrate cycle. By the end of the T phase, my PSA was ~35. That would have scared the life out of me a dozen years earlier. I suppose that I could have shifted to a 2-month T /3-months castrate cycle, but I had convinced myself that a more rapid cycle would be more disruptive to the cancer, so started BAT.
Using Denmeade's T cypionate dosage, I have very high T for at least two weeks. It doesn't seem to clear fast from my thigh muscle. Also, it takes a few days before I get above 1,000 ng/dL. I wish I could afford to test daily, to plot what happens throught my 2-month BAT cycle.
As I mentioned earlier, the PSA trend is the thing to keep an eye on. As long as the trend isn't upward, the actual PSA isn't so important IMO. And an upward trend might be corrected by increasing the cycle (i.e. adding more castrate days.)
Good luck with Schweitzer.
Best, -Patrick
My husband's PSA went up after his first T shot although the rate it increased was slower than it increased pre-BAT. Unfortunately there isn't much data on PSA levels with only one or two injections, so unless your PSA goes crazy after shot #1, the protocol is to continue for 3 cycles. Most (all?) of the studies report using >= 3 rounds of T injections every 28 days.The T often resensitizes Xtandi, so even if PSA rises, they'll start Xtandi again after BAT and see if it works.
It would have been better if my husband's PSA went down after the first treatment, but we are happy with the slower increase in PSA.
There is so little data out there that the docs are all figuring it out as they go along too. Most studies report BAT as being fairly safe, and the jolt of T makes most men feel better.
Did your dad start BAT? What did his psa levels do?
I'm inclined to agree with Patrick: unless your PC is growing rapidly (ie very short PSADT) it doesn't make sense to do two weeks on/two weeks off cycling when you are trying to affect the genetic survival mechanisms of the different sub-populations. I have an indolent slow growing PC and am thinking of doing one month of high-T twice per year. Hard to find a doc to support me in this trial though. Seeking a phone consult with Dr. Mortentaler in Boston.
Thanks for the replies guys.
And I assume you can challenge with Enzalutamide as soon as there is any clinical progression?
The transformer trial indicated the average time before switching to Enza was just over 2 months.
BAT only for CRPC??
Final report on BAT after 20 months
