Apaludimide Titan III -great results - Advanced Prostate...
Apaludimide Titan III -great results
Great post. By the way I have my own Coco only she goes by Cece…
Love Cece!
Roger, you and I are very luck guys to have a beautiful woman by our side during this adventure.
Yup we sure are...LOL
Looks excellent.
Similar to enzalutamide (Xtandi). Similar to bicalutamide (Casodex) but more powerful (enzalutamide is also more powerful).
BAT might help restore sensitivity to enzalutamide. And maybe all of the "mides"?
ncbi.nlm.nih.gov/pmc/articl...
I use some Casodex to effectively reduce the fall-time of T when I stop Androgel and go to ADT (during BAT). I'm meeting with my MO this week and plan to ask her about Xtandi. No BAT trials that I am aware of for resensitization for "mides" other than enzalutamide. An ongoing RCT is going to explore whether it is possible to do BAT/Enza/BAT/Enza/.... If it works, super awesome for many of us. My MO and I think that many prostate cancers might become treatable like diabetes (albeit a lot more complicated to treat).
I hope that adaptive BAT lasts me a long, long time. Barring that I hope that the BAT/Enza trials are successful and that I'm one of the majority of guys who this therapy sequence works for. If I am, how long will it last? Hopefully, until I die of old age. A little morbid joke between my MO and me - if we are successful, the reward is death by heart attack or other conditions. What an awesome reward that is...
On a side note, it would be nice to be able to tell if Zytiga is working. I've been on Zytiga for 3 years. My PSA goes to zero on low T BAT cycles. Is the Zytiga doing anything? If not, I'm just taking on the sides for not much reason other than to line the pockets of the manufacturer.
You might be able to stop the Zytiga on your current regimen. Only by doing a test trial, stop using it for an off-T cycle and see if you produce any testosterone or stay castrate. I wonder also if I could use bicalutamide to help transition from Supra-T to off cycles as the testosterone seems to linger on even with Orgovyx. I was once found resistant to bicalutamide after some years when it started to feed the cancer. Conventional thought is never to use it again. But now with time and MBAT perhaps it could have restored effectiveness. Thoughts?
Good suggestion about the Z. I put it on my list of questions for my MO.
The purpose of bicalutamide during mBAT is to block the ARs, and if that still works for you, I think you could try it.
The thing is that if you are using Androgel for T for at least 4 weeks prior to stopping the high phase, using bicalutamide is almost a don't care. I use it just so that I can tweak in the last few percent of the trailing T edge. But even without it the trailing edge is orders of magnitude better than what they do in clinical trials.
mBAT might resensitize to the mides though so it could be a good test to stay on bicalutamide for an entire low cycle - see what your PSA does.
Up to you. I love to experiment with stuff and take chances to get info. So I would view it as a golden opportunity to see if I am resensitized to a mide. I wish I were in your shoes. I'd love to find out if I'm one of the guys who gets resensitized to mides. Awesome proof of mBAT too. PSA is all that I can go by today.
I have just asked myself the question ... what is the difference in action between abiraterone (Zytiga) and Apaludimide. Perhaps someone has already answered this question.
Zytiga is a cyp17 inhibitor. It stops adrenals and cancer cells from producing testosterone.
Apalutamide (and other "mides") interere with the androgen receptors. They block T from binding. So the tT in serum goes up but androgenic activity goes down.
Very different.
I would like to know which one of these I should start next. PSA currently at 0.26 ug/L.My PSA is creeping up and my Oncologist mentioned starting Apaludimide a couple of months ago.
I have been only on Zoladex since diagnosis in 2017.
If my PSA is going up while on ADT doesn’t this mean I am becoming castrate resistant and should start Abiraterone?
I am going to get another opinion from another oncologist as the one I have doesn’t want to do anything until my PSA gets to 1.0 ug/L.
Also I still haven’t had a PSMA scan and I have multiple bone Mets.
In answer to your last question, Scout. Abiraterone has a completely different mechanism of action from all of the “lutamide “ androgen receptor drugs that block and modulate actions of the receptors specifically. Abiraterone does not directly act on the androgen receptors. Rather it blocks the enzyme that catalyzes the first step in androgen synthesis. (Designated CYP17a) so it stops all testosterone and other androgens from being produced. It does this throughout the body: in the testes, the adrenal glands and in the prostate cancer cells themselves.
Thanks Paul
Great explanation, so if Abiraterone stops all androgens including Testosterone from being produced why use Lupron with it?
My understanding, from my MO, was that Lupron blocks 95% of T and Abi blocks the other 5% produced in the Adrenal gland.
As you can see my basic knowledge of these drugs is lacking.
No abiraterone probably blocks close to 100% of all testosterone production everywhere. So from that perspective Lupron etc ADT is unnecessary. Just that no one has published this yet because of the SOC bandwagon. All major trials have used continuous ADT on all arms. But I personally know of several individuals who have used it without ADT and had castrate to undetectable T levels. However, with T eliminated by abi alone there will still be high LH levels. If this has any effect on PC progression is not known.
Luteinizing hormone is a hormone produced by gonadotropic cells in the anterior pituitary gland. The production of LH is regulated by gonadotropin-releasing hormone from the hypothalamus. Wikipedia
Ok interesting
I recall that there are a few men on this site that have been on Abiritarone only for many years.
I assume the side effects are the same as they are caused by a lack of T not a reaction to the drug themselves.
My sides on Zytiga are rather minor. Blood pressure went up for a while but has come down. I get some fatigue. I don't know if it's responsible for trashing my MMA and Mr. Olympia dreams but doesn't seem to impede muscle gain or libido. No hot flashes. I usually don't take it as per SOC protocol. My MO and I have worked out what seems to work for me and that's a quarter dose with food and only on the low T phases of BAT. It doesn't seem to make me castrate. Again, likely the way I take it.
No that was what i was told when enrolling in titan trial....
One reason that both could be used is this: say Lupron causes a 98% T reduction (seems to be a general response but varies by individual) then a T of 500 becomes a T of 10. Lower is better. So add Zytiga. Block another 98% of what is left. We're left with 0.2. Now we're talking. I don't know if you could increase the Lupron to get to that level but I wouldn't think you could. Different mechanisms and there's a limit to how much of a given drug your body can handle.
Ive been in titan trial since dx 56mos ago....erleada...is jnj name....expensive...but have been undetectsble for 43 mos....no new mets...nadir of .007...psa now .4 maybe starting to wane...s e. Pretty rough with the lupron....lot of muscle loss...joint pain...headaches....but......you pays your money .....
You have a Coco, he's got a Cece and I had a Ohno...........
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 04/05/2022 10:53 PM DST
Probably better than an OyVey.
Great sadness 
Great report
Looking for others with stage III on ADT
Not feeling great
***Great monthly exam. ***
