My Oncologist is willing to do BAT for me in the near future. I am happy to know she is willing to do this.
My concern is that I am not able to determine exactly what is being done. Do you do ADT at the same time , or intermittent ADT , or no ADT. Also, what might be dosage
and procedure.
I need help in what is being done by the doctors who are doing this.
For most of the trials, ADT is constant and is the base. Then testosterone is injected once a month. So as it wears off, you go from a high T state to a castrate T state. There's much more to it, because it's vital to track PSA changes. Your oncologist can request a copy of the trial protocol from Denmeade. This can be dangerous.
Thanks Tall-Allen . Good advise.
Very interesting. Thank you.
With Sam Denmeade's BAT you alternate between high-T & no-T on a 28-day cycle.
Unless on daily oral ADT, ADT is necessarily continuous. Intermittent ADT does not apply.
IMO there is room for tinkering with the protocol. There is nothing magical about 28 days. At what point does T become castrate? (<20 ng/dL) Probably very late in the cycle if one has injected the full 400 mg T cypionate. I favor a 2-month cycle. In any case, the PSA at the end of each cycle is key. You want the trend to be downward or static. If upward, try increasing the length of the cycle.
Also, double-strand breaks aside, 200 mg T-cyp is a valid tweak IMO.
With T replacement [TRT], a small percentage of men see an excessive rise in red blood cells. If hematocrit is >50% TRT should be halted.
Is hematocrit a concern with periodic BAT injections of 400 mg T-Cyp? Perhaps not, but worth checking.
-Patrick
BAT is likely in my future as well now that it appears I have become castrate resistant after having been PSA undetectable for about 6 years. My PCa MO is Oliver Sartor who is one of the authors on the TRANSFORMER trial and we discussed BAT as an option during my last visit. He has several patients who have had really good responses to it and feels that I am a good candidate for it. The way I understand it is that you would continue being treated with Lupron but would discontinue Xtandi while undergoing BAT. T is administered every 28 days and PSA is monitored closely. It’s not unusual to see PSA increase initially followed by a fall. Once BAT is no longer effective you can rechallenge with Xtandi with the hope that you are resensitized to it.
Now I have to get my local MO to go along with this so I don’t have to go to NOLA every 28 days, I can think of worse places to go, and I do love a good oyster po boy!
Ed
TA notwithstanding, proper BAT is not particularly dangerous. Do not take PSA in first month (big spike) but monthly after that. Trend should be evident after 3 months - that is decision time. Patrick's suggestion of a 2 month cycle has some attraction but we do not know much about it whereas the 1 month cycle of Denmeade et al is the best documented so far. Dosage must be 400mg T cypionate to get to full supraphysiological levels. Do a T test (including free T) about 36 hours after first dose to check your reaction. Very important to get to proper supraphysiological levels. (2-3 times the highest of the normal range) Do PSA before first dose, one month after 2nd dose, one month after third dose. Then review. When it fails (not if) rechallenge with your previous 2nd generation antiandrogen. Maintain ADT throughout.
BAT Question
Anyone on BAT or intermittent with estrogen patches? 
Bipolar Androgen Therapy (BAT)
