Does anyone see a doctor who is well-versed and experienced with managing BAT treatments?

[GeorgeGlass]

Does anyone see a doctor who is well-versed and experienced with managing BAT treatments?It seems as though there are few doctors that really know how to plan/manage BAT to their patients. I don't want to pursue this option with a doctor that is trying to "wing it". I already did that with my RO seven years ago, which led to me being in the category of "advanced" prostate cancer.At this point, I don't know enough or understand BAT enough to try it on my own. Thanks,George

[Ramp7]

great question. Looking forward to the responses.

[Tall_Allen]

Almost all the work on it is at Johns Hopkins (Sam Denmeade) and Oliver Sartor (Tulane) or Michael Schweizer (SCCA) may agree to treat select cases. It's only for asymptomatic metastatic castration-resistant patients. It's important to have realistic expectations. The only benefits so far seem to be in extending time on Xtandi and giving some relief from continuous ADT. It does not extend survival. For about a third, it seems to make PCa rapidly worse, and for most of the rest, it doesn't work for more than a few months.

[dhccpa in reply to Tall_Allen]

TA, what does asymptomatic mean in the context of a CRPC patient? Since PSA is rising, what symptoms are missing? Thanks

[meowlicious99 in reply to dhccpa]

Absence of these , i presume

* Cancer pain requiring initiation of chronic administration of opiate analgesia

* skeletal-related event (SRE): pathologic fracture, spinal cord compression, or need for surgical intervention or radiation therapy to the bone.

* clinically significant symptoms due to loco-regional tumor progression (e.g. urinary obstruction) requiring surgical intervention or radiation therapy.

clinicaltrials.gov/ct2/show...

[dhccpa in reply to meowlicious99]

got it thanks. So just new Mets on a scan wouldn't count?

[Tall_Allen in reply to dhccpa]

That diagnoses mCRPC.

[dhccpa in reply to Tall_Allen]

thanks

[noahware]

I think it is important to remember that men with CRPC who fail ADT and then fail Zytiga have a pretty good chance of failing not just BAT but of failing other therapies (like Xtandi), too.

So when PCa gets rapidly worse after initiating BAT, is that worsening necessarily CAUSED by the mode of therapy? I'm not sure that we would say a man who rapidly progressed after initiating Xtandi had that progression "caused" by Xtandi.

Denmeade says BAT "does not produce symptomatic disease progression."

Denmeade:

"BAT was compared directly to Xtandi in men with CRPC progressing on Zytiga. Although BAT (androgen) and Xtandi (antiandrogen) are directly opposite therapies, the response to treatment was remarkably similar. A 50% decrease in PSA level was seen in about 25% of men on either treatment. The duration of response was about 6 months for both treatments. A higher percentage of men on BAT had objective response compared to Xtandi (24% vs. 4%, respectively). BAT was found to be significantly more effective than Xtandi in the subset of men who had a short (<6 months) response to treatment with Zytiga. BAT also showed significant improvement in QOL, particularly in areas of fatigue, physical, and sexual function compared to Xtandi."

"BAT has a potential to worsen pain significantly in men with symptomatic bone pain from metastatic prostate cancer. The worsening pain is probably not due to rapid growth of prostate cancer. Instead, it is more likely due to testosterone-stimulated release of inflammatory factors ..."

"At the outset, the major concern for use of BAT in men with CRPC was the potential to stimulate prostate cancer cells to grow. To date we have observed that BAT is remarkably safe in men with asymptomatic CRPC."

"Many men experience clinical benefit from BAT, even if PSA does not go down or if tumors do not shrink. We often continue to use BAT in those men experiencing such clinical benefit despite an increase in PSA as long as they have stable disease and no evidence of disease worsening on CT scan or bone scan."

"Using PSA to assess response to BAT is very tricky. When prostate cancer cells are exposed to testosterone they are stimulated to make PSA, even if their growth is blocked by testosterone. Thus, we cannot rely on PSA response alone to assess the effectiveness of BAT in prostate cancer patients."

"The use of the bone scan to follow response to BAT is also complicated. BAT can induce an initial flare response on the bone scan, as do many other effective prostate cancer therapies. Spots on the bone scan can appear darker, and sometimes new spots that weren't seen before can appear. Therefore, careful attention must be paid by the treating physician to closely following the recommendation of the Prostate Cancer Working Group 3 in analyzing initial response to BAT in the bone. Patients who appear to be benefitting from BAT but show an initial worse bone scan can be continued on BAT with repeat bone scan in 2-3 months to help determine if further treatment is warranted. "

"The key findings from clinical studies are that BAT (a) can be safely administered to asymptomatic patients with metastatic CRPC; (b) does not produce symptomatic disease progression; (c) produces sustained PSA and objective responses in 30-40% of patients."

[cesces in reply to noahware]

Thank you. So very interesting.

[noahware]

Guys should be aware that the VA high-T trial is only open to vets.

[noahware]

Yeah, just wanted to put that out there for guys who are not vets (like me) who thought they might pursue it.

[cesces in reply to noahware]

Bat is available to anyone who searches for it.

And isn't particularly expensive. Most elements of it will be covered by insurance.

Basically the only part that is out of pocket is the testosterone injections.

[noahware in reply to cesces]

But is "a doctor who is well-versed and experienced with managing BAT treatments" locally available to anyone who searches? Even if you are lucky enough to become a long-distance patient of one of the few docs listed by T_A above, will you find someone locally who is willing to administer their protocol?

I believe many of the major cancer centers (like Dana Farber), and thus their associated docs, do not want to touch BAT with a ten-foot pole. Falling outside of the SOC, it represents too much potential liability.

[noahware]

Don't know yet... but as far as this trial goes, I'm in the "not-need-to-know" camp. My MO has suggested waiting on the testing until the next "fork in the road" arrives. Coming soon!

[noahware]

ADT + Pluvicto

[Shooter1]

I'm apparently in the unlucky 1/3 who don't benefit from BAT. PSA rose from 21 to 116 in first 2 mo. Number 3 cycle gave me intense bone pain in both legs and hips. Just getting back to a normal life at day 8 after shot. Now I know how bad bone pain can effect you.. Inability to sleep, barely shuffling with my cane, slow hard rising from chair, etc. Now waiting for VA to approve new prescription and ship drugs to me... Next blood test should show just how badly BAT has failed for me.

[GeorgeGlass in reply to Shooter1]

in sorry to hear about your response shooter. I really hope that your pain subsided and you get on a different successful treatment. What are you planning to try next?

[cesces in reply to Shooter1]

Shooter, please post what happens as you work your way out.

[Shooter1 in reply to cesces]

Pain subsiding. Still shaky on my feet. Balance off. So much better than 2 days ago. It's day 11 and I will never take the testosterone again. Knees got better first. Hips slow but steady after day 8. No hip pain today. Life Is Good, bad reaction to treatment not so much.

[GeorgeGlass in reply to Shooter1]

what drugs are you on now, an have you been on them? Are u castration resistance or not? Did you ever have imaging that showed tumors in your bones prior to trying the BAT

[Foxewolf in reply to Shooter1]

Shooter

I am scheduled to start BAT in Maryland ( not Hopkins ) next week, have a few questions if you don't mind ( after reviewing your reaction to BAT consider not takin it

Did you have any bone pain prior to first treatment

Did you have you have any bone pain after first and prior to 2nd treatment

Can you think of any warning after 1st treatment that should have alertedt you to pain after 2nd treatment

Did it make you cancer worst

or any other advice I have no other choice the Dr here says there is no treatment and should arrange for hospice care.I am in good shape have no pain walk 2 to 3 miles a day. She doe not recommend BAT as it will cause a negative response to my Prostate cancer I had Pluvicto which didn't work and destroyed by blood work for chemo or all most all clinics.

Thank you

[GeorgeGlass]

what’s GG5?

[GeorgeGlass]

yes, I’m retired Army.

[GeorgeGlass]

i just finished foundation one liquid testing, which showed no mutations.

[Ramp7]

Does anyone see a doctor who is well-versed and experienced with managing BAT treatments? So how many out there are actually involved? Shooter tried it. Smurtaw is, anyone else?

[MateoBeach in reply to Ramp7]

Me. 18 Mo on modified BAT and doing excellent. MHSPC. PSA 0.048. Body and QOL much better with testosterone on board. After every three months of high T I do one month castrate on ADT to keep PC in check (so far).

[Ramp7 in reply to MateoBeach]

I read as much as possible on this therapy. If it's effective and QOL improves. I'd be willing to explore it further. Just completed the trail Study for LuPSMA177. Small spot on tail bone shows new activity. The two initial spots appear stable. Radiation is being scheduled.

[GeorgeGlass in reply to Ramp7]

You show cancer on your tailbone soon after recently finishing the LU-177 treatment ?

[Ramp7 in reply to GeorgeGlass]

Unfortunately yes. It is probably nonPSMA expressive prostate cancer. It appears to be localized.

[GeorgeGlass in reply to Ramp7]

that’s good that is localized. Good luck with it.

[Ramp7 in reply to GeorgeGlass]

We are always hopeful. Best to be prepared for the next song.

[GeorgeGlass in reply to MateoBeach]

That's fantastic MB! Do you do this at home, or get the T at the doc's office?

[MateoBeach in reply to GeorgeGlass]

I get the T-cypionate vials from mail order pharmacy prescribed by my MO every 3 months which corresponds to my BAT cycles. Inject myself at home. Easy.

[dhccpa]

I'm in the same category of understanding (or lack of, except in very broad terms)

[Ramp7]

TMB, stands for?

[GeorgeGlass]

OK, Grade group - I told the doctor that they should rate them from 1-5, just in this same manner. That was 7 years ago. I'm glad they finally instituted my recommendation