Danmeade also talked about TP53. I do... - Advanced Prostate...
Danmeade also talked about TP53. I don't know if it was an independent observation, maybe he read this study.
Do I have this right: If you have a HRD and/or TP53 mutation you are approximately 6x more likely to respond to Bipolar Androgen Therapy (43% to 6%)?
Do I have that right?
If so, that's a pretty important indicator to give BAT therapy a try.... or not.
This study also showed a predictive response to HRD and/or TP53: sciencedirect.com/science/a...
All 15 hyper responders had HRD and/or TP53 mutations.
in response to cesces, I always thought the only way to tell if you were sensitive is just do it. Its cheap, low risk and you know in 3 months. I think even if you have none of those mutations it's worth a try because we know that supra T works in a lot of different ways other than targeting those DNA repair mutations. I last counted 8 separate pathways for Supra T to damage PCa, and I think a major effect is reversal of resistance to lutamides (for a while, as all our treatments are). That is an assault on the androgen axis. BAT in combination with a PARP inhibitor would be an interesting combination.
I agree. Try it and monitor it. Unless maybe your PSA is really high and/or you have mets and bone pain. I'd talk to an MO first if that was the case for me.
In 2019 I tried SPT. 400 mg of cypionate a week
PSA stayed low for two years and then slowly crept up to 0.17. I switched to a BAT like program. PSA was zero and then 0.2 during the high T phase. My endogenous T recovered so I can't say if this is working or not. I'm starting Firmagon sometime in the next few weeks.
MO was surprised and seemed ecstatic with my results on SPT. A minor upside for me is after I did estrogen patch ADT and SPT she doesn't think I'm crazy and is interested in whatever new "stuff" I come up with.
Likewise, I am starting Firmagon for my next “off” cycle after a year with no ADT during off months. I’m 8 weeks on/ 4 weeks off currently. Will do just 80 mg Firmagon to support castrate for one month. PSA 0.11 at end of cycles, a slow creep up, with no ADT. Also wonder if longer cycles might be better: 3 Mo on /2 Mo off? Wild West territory.
I'm playing around with the cycle length. Current cycle is 3 weeks SPT and then 7 weeks of low T.
I expect a slow creep. I calculated the PSADT that I am "comfortable" with. But I need to discuss with my MO. I showed it to her but my charts and therapies lead to information overload (even for me and I created them 
In addition to lowering your PSA did you have metastatic lesions that have shrunk from this treatment?
No. G9, t3b, m0n1.
When you did the SPT, did you stay on Firmagon at the same time, or did you stop ADT during the SPT injections? I'm trying to figure out the specific timeline you guys use. thx
I stopped ADT when I did SPT. I was using estrogen patches (0.3-0.4 mg/day) to get my T to zero. I did that for 6 months and then switched to SPT. 400 mg/wk cypionate injections.
Now I'm doing BAT (PSA was slowly increasing during SPT - went to 0.17 at the end). During BAT I am going to be on Firmagon indefinitely. I've been doing BAT for 5 months and I'm overdue to start Firmagon (for the first cycle of BAT my endogenous T was zero since I was using high exogenous does for 2 years, but now my endogenous is over 300 ng/dl. Not good for BAT but my MO is getting the insurance authorization for Firmagon. Yay!).
I have a book that is in progress at: drive.google.com/drive/fold...
I reckon that was a pretty good response from continuous SPT and despite the oncology textbooks you are still here to report. Did you use arimidex to control E2?
There is a lot still to learn about the SPT axis. Your MO is great. Treasure her.
I used letrozole (another AI). I would have used Arimidex or Aromasin but they didn't work well for me (bloating). I targeted 15-25 pg/ml for E2.
I never really warmed up to the T treatments because I dont think my MOs would support it. I'd probably have to use an oncologist that is already familiar with it and supports it. Do you and RSH have an MO that would be open to new patients? Is it something that adds longevity to most of the men who do it, or is it more for quality of life and not necessarily longevity?
I never really warmed up to the T treatments because I dont think my MOs would support it. I'd probably have to use an oncologist that is already familiar with it and supports it. Do you and RSH have an MO that would be open to new patients? Is it something that adds longevity to most of the men who do it, or is it more for quality of life and not necessarily longevity?
I did it to extend the use of a lutamide. I am in Australia and you will not find an onco here willing to try supra T, or even discuss it in many cases.
I guess QoL. In part this means for me: strong heart, strong body, strong mind (part of the prayer my son and I say every night).
A strong heart, strong bones, and a strong body likely play into longevity.
I self-direct my therapies. I'm comfortable taking these risks. My MO is on board because she has seen the outcome of my crazy therapies. The original 3-month prediction hasn't happened and it is now over 3 years and no signs that I'm going to be hospitalized anytime soon. As she says over and over "whatever you're doing is working, so keep doing it".
could you talk about your choice of Firmagon, is this part of a BAT or ABAT regimen?
Doing the same here. See above reply. On my Medicare plan Orgovix is about $1000 per month vs $0 copay for Firmagon, hence the choice.
It's part of ABAT/BAT. I need some way to keep my endogenous T at zero. I could get an orchiectomy or do Lupron. But I settled on Orgovyx. My insurance company denied coverage but will cover Firmagon and Lupron. Firmagon is a GnRH antagonist so works better than Lupron. I'm going to give that a try. If I need to I can go to Lupron after 4-5 weeks. My T will be zero and a Lupron-type GnRH agonist will be ok - no T flare since I will have done a GnRH antagonist for a month.
Not necessary to know but cool in a geekish way:
Agonists and antagonists both arrive at the same place but in different ways. The reason they work is that they smooth out GnRH pulses (GnRH stimulates LH and FSH - LH stimulates T release) and make it a constant level. Lupron takes it high so you get a T flare until your body figures out that there aren't any changes in the signal. Firmagon takes it to a constant low so no T flare. Sometimes bicalutamide will be used for a few weeks or so with Lupron to negate the flare. Sometimes Firmagon is used with Lupron until the T flare would be over. Most of the time the T flare doesn't matter so docs don't add anything. The exceptions are mets, pain, high PSA and cancer burden.
what is your PSA?
how long do you plan to be on Firmagon?
My PSA on the high T cycles is 0.2. Interesting that it never fails to go to 0.2 and never exceeds it.My PSA on the ADT cycles is zero. But this last cycle it only went to 0.18. I hope that is because I am not on Firmagon yet and my endogenous T is about 300 (lab results and calculations lead to that number).
I plan to be on Firmagon until BAT fails. Hopefully, that is at least a year or so out. And after it fails I'll likely still be on Firmagon in preparation for radiation. But that's kind of too far out to know for certain.
And if Firmagon gives me bad side effects then I can switch to Lupron. My MO thinks that some guys can't handle the T slam from Firmagon (GnRH antagonist). If that's the case we agreed that it should not be an issue for me.
Do I understand correctly that you and MateoBeach are both using Firmagon as the PSA surpressor phase of the BAT cycle?
I am. I think MateoBeach is also...?
Had meeting with MO at U of C this morning and it was not very encouraging relative to BAT.
Can't say I am surprised considering this is your initial treatment.
Most MOs aren't going to be high on BAT. Mine is fine with my doing it but I think that's primarily because she's known me for 3 years.
I was hoping to get him interested in managing a BAT approach once I was done with Radiation and ADT. With the goal to keep me from becoming resistant. Looks more and more like I will have to manage BAT myself as others on here are doing.
You may be able to find another Dr willing to assist. I would just have to wonder if they would until they can gauge your response to the initial treatment.
Does he recommend an ADT lead-in? That might be palatable. It can be tweaked so that muscle growth and bone growth are taken into account. I've remarked several times that my ADT sessions are nothing like my ADT 3 years ago. 3 years ago I became a skeleton with boobs. Today I bulk up.
Before you go CRPC I'd go for BAT. That is me though and I'm always willing to take risks to get rewards.
If your PSA is high or you have any mets or need to debulk the tumors, an ADT lead-in could do it before you go to BAT. If not, I'd go straight into BAT. This is the time to try it. The optimum time is not later when you have issues. Again, my opinion. If BAT worked for me I might go into SPT. I don't know why I said "might". For 2 years I did go SPT. Worked well to the surprise of my MO and my distinct pleasure. For 2 years I felt like a 35-year-old.
