Newer Review Article on Testosterone Replacement and BAT out of China

[MateoBeach]

At the risk of throwing yet more "gasoline on the fire" if this discussion topic, I think it is important for those interested to review what we know (and do not know) as of now. This is a most recent review of the topic out of China. (Not the only nor even the best review article. But a good review just the same.) The devil is in the details!

reader.elsevier.com/reader/...

Concluding remarks and future perspectives

"The historical view of androgen as an energy source or driver of

malignant growth of PC has proven contradictory. Numerous

studies have reported the safe results of TRT application in

non-PC and PC populations, indicating that the actual health

benefits of alleviating TD symptoms and improving quality of

life might outweigh the theoretical but unproven risk of PC

progression.

New clinical and experimental data suggest that the

high androgen levels induced by TRT could be protective

against progression or subsequent tumor recurrence in earlystage

PC. In metastatic or locally progressive PC, TRT is more

likely to be discontinued owing to worsening clinical symptoms

or PSA progression, which could be due to increased

levels of AR and AR mutations in PC cells following endocrine

Drug Discovery Today Volume 00, Number 00 March 2021 REVIEWS

DRUDIS-2925; No of Pages 9

Please cite this article in press as: Xie, T. et al. The role of androgen therapy in prostate cancer: from testosterone replacement therapy to bipolar androgen therapy, Drug Discov Today

(2021), doi.org/10.1016/j.drudis.20...

TABLE 4

Summary of the results of completed trials with BAT

Authors No. of

patients

Patient population Treatment regimen Outcomes Refs

Feltquate et al.

(2006)

36 Progressive PC (increasing PSA and

clinical metastases)

Testosterone on days 1 to 7, and

an estrogen patch on days 8 to

21

No imaging and clinical progress,

and PSA decreased continuously

[62]

Szmulewitz

et al. (2009)

15 Early CRPC (with minimal metastatic

disease)

Transdermal testosterone at 25,

50 or 75 mg/day

One patient experienced

symptomatic progression, and 20%

(3/15) demonstrated a decrease in

PSA (the largest was 43%)

[64]

Morris et al. (2009) 12 CRPC (disease burden or symptoms

not designated)

Testosterone via 5 mg

transdermal patch or 1% gel for

1 week, 1 month, or until disease

progression

30% of the patients showed PSA

declines; one patient showed a PSA

decline of >50% from baseline

[65]

Schweizer et al.

(2015)

16 Asymptomatic CRPC with low to

moderate metastatic burden

Testosterone (400 mg

intramuscularly day 1 of 28) and

etoposide (100 mg oral daily;

days 1 to 14 of 28)

50% (7/14) experienced PSA

decline, with 28.6% (4/14) showing

a PSA response of

50%. Of the 10

patients who had evaluable soft

tissue metastases, 50% had

assessable imaging regression

[79]

Schweizer et al.

(2016)

29 HSPC (with low metastatic burden

or biochemically recurrent disease,

who achieved PSA < 4 ng/dl after 6

months of ADT)

Testosterone 400 mg

intramuscularly on days 1, 29,

and 57

59% (17/29) had a PSA level of

< 4 ng/mL at 18 months; 80% (8/10)

objective responses were observed

(four complete; four partial)

[80]

Teply et al. (2018) 30 mCRPC post progression on

enzalutamide

Alternating 3-month cycles of

BAT (400 mg intramuscularly on

days 1, 29 or 57), followed by 3

months of ADT alone

30% achieved PSA response; 29

patients progressed on BAT, 52%

regained PSA response to

enzalutamide treatment

[81]

drugdiscoverytoday.com 7

Reviews POST SCREEN

therapy, resulting in increased sensitivity of cancer cells to

androgens.

It is evident that TRT still needs to be used with caution in

patients with progressive PC. But the indications from the available

studies are that, after rigorous screening, TRT can be applied to

hypogonadism in patients with AS or low-risk PC after radical

treatment.

BAT, which is based on studies of TRT, is an emerging innovative

strategy that has changed our understanding of testosterone

and its interaction with PC. Existing evidence supports BAT as an

appropriate therapy for men with treated PC, particularly those

men with low to moderate metastatic burden or castrationresistant

cancer. However, not all patients exhibit a positive

response to BAT, which is common in all cancer treatments,

although it emphasizes that there is still much research to be

done before BAT can be widely applied."

[Hidden]

And away we go.

[LearnAll]

Thank you for this information. This is one of the most fascinating emerging area about PCa treatment.

[Hidden]

I wish someone would figure this shit out so people wouldn’t have to unnecessarily reduce their natural testosterone

[Hidden]

In my trial of one I had sub 2 PSA readings PSA all while I was taking a low dose of Androgel Testosterone 2009-2016 and then quit in 2016 for fear of getting prostate cancer. As well as tiring of dealing with insurance requirements. My PSA then rose a little each year and in 2019 was 7, then 9, when I was diagnosed at the end of the year, early 2020. So to me, there was a cause and effect of stopping testosterone treatment causing cancer. I know it could be said it was already there. Who knows. I just wonder what would have happened if I never quit.

[j-o-h-n]

Sex did it to me................................................................................................................................not enough...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/08/2021 5:24 PM DST

[j-o-h-n]

BAT out of China is what got us in this mess in the first place.............

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 04/09/2021 11:46 PM DST

[MateoBeach in reply to j-o-h-n]

Indeed John. Very much like a BAT out of hell.