PSA rising on BAT

[Arthur479]

I have been on BAT for about 9 months. My PSA dropped slowly from 9 to 6 over several months and now has risen back to about 9. One complication has been the high estradiol which we have yet to get under control.

We started measuring estradiol (thanks to Friedman's book) a month or so into BAT and it came in at an astounding 200, and then started with 1mg arimidex/day and that got it down to 180, lol. Upped it to 2 for a couple months and now is at 100. (Normal is 15-30) . My onc is upping it to 3/day and I am pressing for 4. (no response on that request yet).

BTW, these measurements are taken just prior to the monthly shot.

Anyway, trying to understand when is the time to switch off BAT given that perhaps lowering the estradiol to normal may reverse the trend. Yes, I am biased, I like that BAT, lol. But I don't want to be stupid.

[Arthur479]

Thanks for the insight. I don’t believe there has been a DHT test. I will ask about that.

Dr. Beck of Highlands Oncology in Rogers, AR is my guy. An outstanding doc and human being.

[cesces]

It sure seems like It's not working and that it's time to change strategies.

What is your doc saying?

[kaptank]

The TRANFORMER trial showed that BAT followed by enzalutamide was an effective use of that antiandrogen because BAT seemed to sensitize the cancer to enza's use. Although the trial only used patients who had not previously had enza (but had failed abiraterone) there is other evidence that someone who has failed enza and done BAT may well find that after BAT, the cancer is again sensitive to enza. BAT seems to sensitize the cancer to the lutamides. In my case it was bicalutamide. It does not seem to work for abiraterone which has a different action.

healthunlocked.com/advanced...

[Arthur479 in reply to kaptank]

Thanks for that info! I have stayed on enza and Lupron the whole time of doing BAT. Not sure where this leaves me exactly, except it does seem time for a change of some sort. The doc has previously hinted that chemo and lu-177 are on deck.

[kaptank in reply to Arthur479]

I am not so sure about using enza and BAT together. If you are trying to overwhelm the cancer with supra T, it seems to me that simultaneously using an androgen blocker is counter productive - it stops the T from getting to the cancer cells. Ordinary ADT (lupron etc) is OK and necessary since it stops the body's production of T but does not block any exogenous T that is introduced. I think it is important to clear the body of anti androgens/blockers before starting or injecting T. Note that dutasteride (avodart, a weaker anti androgen) has a long half life and takes about 6 months to clear so I think it may not be so useful in conjunction with BAT. This is just supposition on my part.

I agree that it looks like BAT has failed for you. However that may not be the end of it. In my case it also failed at about 9 months but rechallenge by the previously failed lutamide (bicalutamide in my case) gave about another year. Then I tried to see if the trick could be repeated. It could be, but with steadily diminishing returns. By about the 3rd repeat it looked like the game was up. However that gave me about 4 years in addition to the 1 year that bical gave me before its first failure. One thing you could try is continue the enza without BAT, then when that fails (I always look for 3 one monthly PSAs -or a scary spike above comfort levels - in a rising trend but in your case I would look for only 2 ) Then try BAT again without enza, followed by enza when that failed. That however is risky because it may not work and you will have lost time before going on to the next treatment. Note that docetaxel also seems to resensitize the cancer to enza, so a less risky path may be to do docetaxel then enza. (or even docetaxel followed by BAT followed by enza.) At least the docetaxel should get PSA down to comfortable levels.

I found that the supra T did cause a spike in E2 which fell back to less alarming levels as T diminished over the month. I didn't use an anti aromatose. (my onco refused saying that's what you get for playing with illicit steroids. I got a new onco) It is really good that you found an onco prepared to look at T. There are none here in Australia where T is heavily watched and any onco who prescribes it to a PCa patient will get a nasty "please explain".

I think Patrick also makes sense in suggesting longer cycle times eg BAT for 2 months, perhaps with T shots every 2 weeks then at least 2 months on ADT without BAT.

We are still learning. The early one month BAT cycle was used in the first trials because it was the safest way to start investigating the effects of supra T - you get to know if it works or not pretty quickly.

[Arthur479 in reply to kaptank]

Hey that is some amazing dancing with the medications. A lot to digest in that post. Really appreciate you taking the time to offer these insights!

[pjoshea13]

Hi Arthur,

I tried the monthly BAT protocol, but it didn't work for me. So I increased the cycle to 2 months & got the PSA under control. However, I sometimes add a third month if the PSA is somewhat higher than at the end of the prior cycle. I wouldn't give up on BAT yet.

Estradiol of 200 pg/mL? Crazy. Don't know what to suggest beyond higher doses of anti-aromatase.

Natakrats advice regarding Avodart is good IMO.

-Patrick

[Hidden]

I used Arimidex and it didn't control estrogen. Same for anastrozole. Letrozole worked though. I was taking 2.5 mg/wk but my E went too low. Now I take 1.25 mg/wk.