intermittent anti androgen monotheray and bipolar androgen therapy

[rococo]

casodex mono therapy raised T to 1000 and going off cycle exposing naked pc to high T would be a mild form of BAT. MAYBE EVEN MORE WITH NEW AA. Has anyone thought of this interesting possibility. I have done this once for a 2-3yr period of 23 yrs of HT

[Tall_Allen]

Because of negative feedback, Casodex will only increase T to a limited extent before your testes stop making T.

[cesces]

"mild form of BAT"

Mild form of BAT apparently doesn't work

It has to be extreme levels of Testosterone apparently.

Merely elevated levels of Testosterone is likely the worst of both worlds.

The only thing worse is do it yourself BAT therapy. Nothing good can come from that.

You really need a Doc with hands on BAT experience.

[Ramp7 in reply to cesces]

I think that is the tricky part. Haven't explored it completely but how many MO's out there doing BAT?

[cesces in reply to Ramp7]

Npt so many. You want a doc that participated in denmeades bat research

Off the top of my head there is Sartor at Tulane. There are others mentioned in these forums.

[cigafred in reply to cesces]

Including Antonarkis in Minnesota and Schweizer in Washington State.

[cesces]

"casodex mono therapy raised T to 1000"

Dumb question: I thought you used casodex to lower testosterone levels. Not increase them.

[noahware in reply to cesces]

Casodex works on the androgen receptor, not on reducing T itself. While it is an AR antagonist, the serum levels of both T and E2 rise. (On 150mg monotherapy, my T level went to about 1500, as PSA dropped from over 30 to under 5.)

While the higher T does not impact PC progression, since AR is blocked, the higher E2 level DOES impact growth of breast tissue!

[cesanon in reply to noahware]

Ahhh just what I need. Bigger man boos. LOL

[noahware in reply to cesanon]

Yeah, and to make it worse, my left got a little bigger than the right!

[MateoBeach]

rocooco, I have been considering a closely related question. I am on modified BAT (very high T for 3 months then 1 month on Orgovyx ADT. I am wondering if the ADT phase would be even more effective if I added an anti-androgen. Because:

1) The combination of ADT plus and AART drug has better results for PFS and OS and also delaying castrate resistance in every clinical situation that it has been tested (in RCTs).

2) Blocking androgen receptors further intensifies the selective pressure against AR+, hormone sensitive population.

3) This with ADT promotes AR amplifications and copy number increases which should make the more AR resistant populations even more susceptible to the High Testosterone cycles.

Personally, I cannot use bicalutamide for this since I previously failed while on it and it now feeds rather than blocks my cancer. So I cannot safely go back on it. So it will have to be enzalutamide or darolutamide. Abiraterone is another way to intensify androgen deprivation during the ADT phase. But hard to cycle rapidly with the prednisone requirement.

As has been said, probably just cycling the bicalutamide may not provide high enough testosterone levels to provide true BAT effects. But would be easy for you to measure and see. Would shoot for above 1500 total T, then ideally <20 on the off phase.

[noahware in reply to MateoBeach]

Is there any research on resensitizing one's PC to bicalutamide? I recall that niclosimide (?) and/or disulfiram (?) might help make abi effective again after initial failure, and I thought someone posted on a potential agent for doing so with bicalutamide. Ring any bells?

[MateoBeach in reply to noahware]

BAT has been shown to resensitize to enzalutamide. So I am just theorizing it might do the same for bicalutamide. Trouble is how to test and confirm that? Would require staying on it and getting serial PSAs. That would interrupt the BAT,so Catch 22.

[rococo]

AA ie. the lutamides do not lower T but block it. In response the testes produce more T as mine remained high for years on casodex 700-980 T, Didn’t know at the time, Thought I was a 70yr old buck. Now 84 and still kicking on. Best to all

[Benkaymel in reply to rococo]

That makes sense, but I started my treatment in early July on bicalutamide alone for 2 weeks before my first Prostap injection (to prevent tumour flare). The bica continued for 2 more weeks and I had a blood test at the end of the 4 weeks on it (so just 2 weeks into ADT). T was already down to 9.8 which I was told was most likely due to the 4 weeks of bica rather than Prostap since it had only been 2 weeks since my first shot. Now I'm confused! Could ADT bring T down that quickly?

[MateoBeach in reply to Benkaymel]

yes it can and evidently did so.

[Benkaymel in reply to MateoBeach]

I'm still confused. Tall_Allen said "Because of negative feedback, Casodex will only increase T to a limited extent before your testes stop making T" so how could it increase to over 900 and keep it there for years? Also, my experience implies that ADT in 2 weeks can reduce T by far more than Casodex increases it in 4 weeks.

[noahware]

If I was trying for a "high T" with thoughts of BAT, I would shoot for over 2000 (= "supra-physiological").

[Ramp7]

I have a dumb question, what is AA?

[Hidden in reply to Ramp7]

I love you!👍

[MateoBeach in reply to Hidden]

Thank you for your service. 🫡

[Hidden in reply to MateoBeach]

any time

[MateoBeach in reply to Ramp7]

Abiraterone acetate = Zytiga plus prednisone.

[Hidden]

I'm sorry, but posts with so much alphabet soup are so frustrating. I have no idea what you said.

[MateoBeach]

I’ll try to help: AA is abiraterone acetate, total inhibitor of testosterone synthesis. ARSI is androgen receptor signaling inhibitor also confusingly called AART inhibitors, advanced androgen receptor targeting inhibitors, and others! Refers to enzalutamide, apalutamide and darolutamide but not bicalutamide. AA is often grouped with these even though it is different in how it works. RCT is randomized clinical trial, the highest level of clinical evidence.

Within BAT, bipolar androgen therapy, SPT is Supra-physiologic testosterone or the High T phase. It alternates with very low testosterone cycles, castrate T or close to it. Smurtaw is experimenting with adding AA or ARSI to ADT to intensify his castrate T cycles.

[Hidden in reply to MateoBeach]

thanks so much Mateo, the abbreviations are too many to look up sometimes. This helps!

[MateoBeach]

See my reply to Yingsang above. Smurtaw is very smart but his regimen is indeed complicated!

[Benkaymel]

Thanks Russ. I knew that ADT works by suppressing T production and there is T flare initially. Also, that ARs blocked reception of T so bicalutamide was used to deal with the flare - and of course, block the cancer from getting the T. What I didn't know until now was that the lutamides also substantially increased T serum levels. It seems counterintuitive.

Learn something new everyday!

Using your analogy about buckets, it's like when Mateo sneaks up and puts sand in them, it also causes the rain intensity to increase 10 fold! (However the buckets still only hold 20 gallons and Lupron still keeps 99% of the clouds away so it compensates for the increased rain.)