Do medical oncologists have a bias against BAT and is it justified

[nuc1111]

Part to the difficult balance between lifespan and quality of life? Appreciate your opinions

[rsgdmd]

I suppose it depends on the doc. I thought my MO was a real SOC kind of doc, but she mentioned pretty early on about down the line, if needed, sending me to Johns Hopkins for BAT.

[Shooter1]

My MO had never done BAT but when he and my RO got to the point where they told me they had nothing else they could do for me, they agreed to try BAT. Hope it works. Trials seem to show improvement for 70% of people. Kills 10%, cures 10% and everyone else in the middle somewhere...it hasn't killed me yet.

[Tall_Allen]

Not a bias. It is very experimental and should only be done in a clinical trial.

[Seasid]

Would you be so kind and feel out your profile? It would save us some time going through your posts and we could maybe give you a better advice?

[Cooolone]

It's funny because of the limited mainstream access, ie, trials, patients have to kick stones and search out oncologist who are willing to submit to cutting edge therapies regardless of what they are.

We are the PATIENT who will ultimately suffer either the benefit or detriment of a therapy, and we should be able to be the final word on our path. Especially with something like BAT that isn't so crazy or off the shelf... What's the worst that happens, we feed the cancer and it progresses? Monitoring PSA monthly would allow the effect to be observed and mitigated before any real issue. It's ok to take drugs to inhibit production of testosterone or cells to receive it, as a therapy that began use in the 1940's, but heaven forbid we want to try a paradigm conceived in the last decade! Lol

My MO wasn't so enthusiastic either, but that was when I was persistent PSA post RP, we haven't really discussed this path over the last 2 years, but it may be forthcoming. And quite frankly if it's something I want to do, I'm going to do it, find the resources to accomplish what I want as my treatment. Easiest way would be to get on Orgovyx, use it intermittently, with the high dose T, cycles are available on the net, through study information, and do it yourself! Lol... But oh my, could you imagine the thought of a patient self treating? Regardless of the results. That's the control that some want, and is a human affliction to determine one's own destiny, direction. So what's the problem?

Sure, the jury is still out and absent large scale controlled environments, it's difficult to assess it's true efficacy. But there's enough evidence that exists to support it does work. The real question would be to try and determine why it works for some, and not others.

Anyways...

Best Regards

[nuc1111 in reply to Cooolone]

Love it-Ed

[Seasid in reply to Cooolone]

I believe it is genetic.

[MateoBeach in reply to Cooolone]

Exactly - We are all a trial of one. If asymptomatic and PSA is reasonably steady then the downside is very low even if it does not work for an individual, Just stop it. For many, like me, modified (longer cycle) BAT is a godsend. Paul.

[SteveTheJ]

Mine does not. If yours does, find another doc.

[EdBar]

I think it depends on the doc, most are not familiar or experienced and it seems very counterintuitive to them. My MO is doctor Sartor who is very experienced and has overseen trials using it. He offers it outside of a trial to his patients who meet a certain criteria. He has had good success with it. It’s probably going to be the next step in my treatment once my MCRPC PSA reaches a level where a PSMA scan is in order, so we can see what’s going on.

Ed

[Teufelshunde]

From your profile you went thru almost a year high T and now in a low T phase? Is low T phase just stopping T or adding ADT for a period?

[Currumpaw]

"Frequently it takes a new generation of minds."

I like that perspective! Throughout history free thinkers, often maligned by the luminaries around them, have given us some of the greatest gifts bestowed on mankind. Space travel today rather than sailing off the edge of the earth. Rigid tunnel vision limits the possibilities open to us.

I am glad your MO has the experience and intellectual depth to have tried what seems to be a very positive treatment for you.

My very best to you,

Currumpaw

[Spyder54]

It is early days for BAT. Most BAT Trials are 30 days of Supra-physiological high T (900 to 1200), then 30 days Castrate T (below 20). But….we have many N=1 on this site. My favorite is 3 months High T with weekly injections for 11 weeks, then T Cream for 12th week which has a much shorter half life allowing a quicker transition to Castrate levels. Then 30 days w ADT to close to Zero T. Repeat 90/30.Some will work up to 90 always with 30 day PSA/T checks. It appears that a big part of this is that it confuses the PCa, and does not give it time to figure a workaround which prevents Castration/Hormone Resitance.

Like Tall Allen says, better in a Trial setting with smart Medical Oncologists (MO’s)to monitor. Problem is, so far, I have been unable to find one in the Tampa Region. My URO/ONC says he will work with an MO, but will not do on his own.

Personally, I do not want to wait until I am Resistant. I want to extend that far off into the future.

MY WISH IS WE COULD HAVE ALL THOSE MEN ON mBAT share their personal experiences so we could come to our own conclusions. Almost like a separate HU site, kind of like a Secret Society. In my opinion, we are all just one big human experiment anyway. Water is constantly changing. Evidently Charles Huggins had lots of notes on high T when he won the Nobel Prize for proving low T worked to extend life in Men with PCa.

Early Days, Mike

[nuc1111 in reply to Spyder54]

Love it-thanks

Ed

[Cooolone in reply to Spyder54]

Personally, I do not want to wait until I am Resistant. I want to extend that far off into the future.

^^^THAT^^^

Is what we all want to avoid as the progression to resistance accelerates the known conclusions!

[MateoBeach in reply to Spyder54]

Yes, Mike. As we have shared before on HU. My experience is in my posts and comments. find someone like Sartor or have your own MO consult with him (or similar).Better before becoming CRPC, even though the early trials did not include HSPC except for small series (which looked favorable.

BTW, the early studies on BAT at 400 mg T-Cyp every 28 days NEVER got the patients to castrate T levels, despite underlying ADT drugs. The half-life of T-Cyp is too long for that to happen. That is just one reason why 28 day cycling with T-cyp is just too short to be maximally effective. Spread the word, Amigo.

[nuc1111]

Thank you-Ed

[dadzone43]

I wish that your profile had more information about your prostate cancer. You know: numbers.

"Bias"? Oncologists are trained in science and promote treatments that have valid scientific proof. In the absence of definitive studies they have to guess. Just as you do. Or I do. In my case, my MO and RO had science to back up their suggestion that I should get "salvage radiation" plus ADT after my prostatectomy. They were biased _for_ that treatment. I was biased against it, not because I doubted the trials, but because I wanted evidence that my PCa was persisting and I needed "salvage. " I chose to monitor my PSA and make another decision if it started to rise. At 3.75 years I remain undetectable. It was a struggle with the MO and the RO. I remain alert. Meanwhile I have avoided the life-altering effects of ADT and the risks of RT.

[nuc1111 in reply to dadzone43]

Thank you- smart man- Ed

[garyjp9]

Hi, would you be OK sharing her name/city? The good ones are not so easy to find.

[Seasid]

Thanks

[Seasid]

You can also add this BAT clinical trial in Sydney to your list:

clinicaltrials.gov/ct2/show...

[Seasid]

Clinical Efficacy of Bipolar Androgen Therapy in Men with Metastatic Castration-Resistant Prostate Cancer and Combined Tumor-Suppressor Loss

sciencedirect.com/science/a...

Abstract

Bipolar androgen therapy (BAT) relies on oscillating levels of serum testosterone as a way to treat patients with metastatic castration-resistant prostate cancer (mCRPC). Aggressive-variant prostate cancers typically require combination chemotherapy and are frequently associated with loss-of-function mutations in tumor suppressor genes. Here we report clinical outcomes after BAT among patients with mCRPC harboring pathogenic alterations in at least two of three genes: TP53, PTEN, and RB1. In this setting, BAT induced a meaningful PSA50 response rate, progression-free survival and overall survival, particularly in patients without prior chemotherapy.

Patient summary

Bipolar androgen therapy, in which drugs are used to raise testosterone levels and then allow them to decrease again in a cycle, may be a safe and effective treatment for prostate cancer that is resistant to testosterone suppression and has mutations in tumor suppressor genes. A randomized study comparing this approach to chemotherapy is needed to confirm the findings.

[Seasid in reply to Seasid]

Are they aware that you have a worse prognosis to chemotherapy?"And men with p53 mutations also appear to do better with BAT." The BAT paradox. It was that patients with p53 mutations that always portend a worse prognosis to basically all therapies that we have, including chemotherapies as well, actually those men with p53 somatic mutations are more sensitive to BAT. They do better with BAT." The idea is that they don't have effective DNA repair mechanisms to repair the genetic damage to PC cells caused by BAT"

[Seasid]

Good point.

[Soumen79]

Is BAT practiced in Canada, any reference?

[Spyder54]

Smurtaw, thinking the trend is more like 25% of the time. 3 months high, 1 month low. The 50/50 studies were not conclusive. The body is too busy in the ups and downs vs getting up there, and staying for 3 months with final 2 weeks on a T cream to underside of forearms, for its ability to leave the body 4x faster than injectable T cypiate. You need to get T down close to zero, and PSA back to very low/undetectable. Mike