Background: I am T3c, N+, M0 HSPC. Dx in 2007 with Gleason 4+3. RARP neg, Margin positive w ECE and SVI on left. 13 nodes negative and scans clear. Elected 6 cycles of early Docetaxel, then SRT to prostate bed only, all in 2007. Intolerant/allergic to leuprolide so I did alternative ADT after BCR with bicalutamide 50mg plus dutasteride for 5 years before it failed. In 2019 I had Ga-68-PSMA scan showing only two PLNs in pelvis on left side. No activity elsewhere. So I did hemipelvis IMRT, 64 Gy with boost to the 2 nodes. Adjuvant ADT for 6 months (Firmagon plus Estradiol patches.) For over a year after completing this my PSA slowly decreased down to 0.080 (from 0.28) But my testosterone did not recover above around 100.
I was experiencing the full range of hypogonadism symptoms: ED with zero libido; decreased bone density (on Prolia); decreased muscle and lean body mass; cannot put on muscle despite heavy weight workouts with trainer; poor exercise recovery; Mood lability with depression, anxiety and irritability; fatigue and lethargy; decreased mental focus and concentration; insomnia with early morning waking. The only hypogonadal symptom I did not have was increased body fat, thanks to my keto diet and OMAD fasting.
For several months I reviewed ALL of the peer reviewed research on testosterone use in prostate cancer as well as the BAT trials. I decided to do a personal trial of high dose testosterone for one month and follow the results with my PSA levels. Those who will respond favorably or unfavorably to BAT protocols cannot be predicted. But they can be identified. Nearly universal is a moderate increase in PSA when testosterone or first BAT cycle is started. Favorable responders will have a subsequent decrease when the testosterone is stopped (due to concomitant ADT). Poor responders have progressive increases in PSA without stabilization. These men must stop the BAT and are dropped from the trials.
It took me several months of pleading with my MO and barraging him with the clinical literature, as well as getting several consults with urologists familiar with testosterone in PC. These included Tomazs Beer at OHSU and Michael Schweizer at Seattle SCCA (notable BAT researcher). Finally got the nod despite the usual cautions. I wrote and signed an informed consent document for my chart.
March 1st I had my first dose of Testosterone: 200mg of T cypionate IM. In 2 days I felt: TERRIFIC! My energy and attitude was restored. Libido returned. My head clear and mood bright. It was astonishing how positive and immediate the results were. I had two more doses at 2 week intervals to make approximately 6 weeks total on the testosterone cycle. ( I did not opt for the 2 weeks of High T and 2 weeks of castrate as per the BAT protocols because I am hormone sensitive and my cancer has been indolent and slow growing. So the rapid cycling did not seem to fit my cancers growth/reproduction rate.)
Last Wednesday, 10 days after my last of the 3 injections my testosterone level was 801 nG/dL (12.6 free T). And my PSA was 0.180 (up from 0.080) before the testosterone cycle. I count this as the expected "moderate" rise that is expected in the best of responders. Now I will do the 2nd have of my cycle test program. No more testosterone for 2 to 3 more months with monthly PSA tests. I am not doing ADT this time and will see how my T levels decline naturally.
My intention is to consider doing a one month or 6 week cycle of Testosterone perhaps 3 or 4 times per year if my numbers stay stable. Enough to keep the hypogonadism in check without allowing my PCA to run wild. I am only reporting on my own experience so far with a treatment that is unproven in my clinical status. This is being done outside of a clinical trial but modeled on modified protocols being used in BAT trials currently underway. I make no claims for it and do not advise others to do similar. So far I am very happy with my response.