BAT treatment - when initiating?

In the trials the req is PSA above >1 ng/mi. Currently I have 0.1 and stable - using Olaparib. Should I start asap or wait until progression? Is std BAT to be preferred or utilize the new schemes current in trials. Any advice - I guess mant are in the same situation . (Chemonaive and prostate intact.)

[Shooter1]

SOC BAT or what is in trials?? That is why trials are run, to find out which is better... We will know more when trial results are in.... I wish I knew now as I am on standard BAT now.... :You have a long way to go with intact prostate and no chemo.... Best of luck on your travels through treatments...

[Hidden in reply to Shooter1]

I contacted John Hopkins, they d’ont have data yet for the alternative schemes: «The two months on two months off schedule is currently being tested in a trial. I don’t have any data yet. All of our data is one cycle of BAT until progression then switch to enzalutamide. We have a second arm testing repeat of that but again no data yet. I have treated some men with Bat until progression than Enza then repeat and have seen repeat response in some.»

[maley2711 in reply to Hidden]

By "I have treated some men........" you are paraphrasng the answer from JH......YOU are not an MD are you?

[Hidden in reply to maley2711]

No, that was the answer from John Hopkins about different BAT therapied

[Tall_Allen]

Risky. But maybe you will get lucky. It has to be watched very closely. IDK what other scheme you are referring to.

30 heavily-pretreated men who were mCRPC and who have progressed on either Zytiga or Xtandi, received BAT and the PARP inhibitor olaparib. Half had DNA damage repair defects. This was hypothesized based on lab findings.

urotoday.com/conference-hig...

• ¾ had at least some PSA reduction

• 47% had a PSA reduction ≥ 50% (44% if 2 who dropped out for progression are added)

• 23% had a 12-wk PSA increase ≥50% (28% if 2 who dropped out for progression are added)

• Median progression-free survival was 14.8 months if they were mutation-free vs. 7.5 months if they had the defects.

• 2 patients had a complete PSA response

• 5 of 8 90+% responders were free of DNA damage repair defects

• 3 of 6 90+% progressors had DNA damage repair defects

• 5 patients had serious (grade ≥ 3) toxicity, including one death

This trial suggests that BAT + olaparib achieved good response regardless of DNA damage repair defect status. Excellent responders had mutations of the T53 gene or DNA repair genes (see below). The cause of responder/non-responder differences remains elusive.

clinical-genitourinary-canc...

[Hidden]

Risky, yes - you are right. The best would be to have a ctDNA, if TP53 and not RB1 is present then the risk would be substantial lower. All cases with PTEN Loss + TP53 were favorable.

If you are lucky, it seems that the sensitivity to a later CPI is much better.

My soc option is Cisplatin, the results are very disappointing.

[Tall_Allen in reply to Hidden]

Carboplatin+Jevtana tested well:

pubmed.ncbi.nlm.nih.gov/315...

[Hidden in reply to Tall_Allen]

You are right again, it seems that the results are about even. Maybe one exception, chemonaive has better results, in this trial 38 months OS median. ( All high Gleason CRPC progressed on Enza/Abi)ncbi.nlm.nih.gov/pmc/articl...

[KocoPr]

When you say a “different form of T should be used so that during low T phase a true castrate level can be achieved “Do you mean T…propionate because it gets T up fast and dissipates in 4-5 days?

[KocoPr]

Im not there (BAT) yet but love continuous learning and input to reinforce my understanding for when I may need it.

[KocoPr]

Does that T Prop need to be prescribed?

Also AI =Androgen Inhibitor? Like the lutamides, not the antagonist like lupron?