I would like to know for those folks experimenting with BAT or actively doing so with their MO once your T rises again and then when you reinitiate ADT do you go through the whole hot flash cycle again? Is it the constant back and forth feeling of feeling great and then like crap?
I am still hormone sensitive but curious how one actually feels doing this treatment?
For men with mCRPC, they never go off ADT, but at the start of each month, they inject testosterone and let it wear off. It can be dangerous and should only be done within a closely watched clinical trial. So far, there are no definitive tests for men who can stick with it for a while vs those who do a lot worse.
Thanks for the response. Seeing some new info on these studies and it seems like there are several folks who are doing this. With or without oversight it seems.
Some people are willing to take any risk to get the monthly breaks from the side effects of ADT. And that's all you can reasonably expect - no increase in survival. Maybe someday they will discover a biomarker that will help us select patients who won't be harmed by it.
I am meeting with Denmeade tomorrow. The discussion shall be BAT. My regular MO will go along with Denmeade's recommendation. Thoughts center on cycle length, and achieving a very low T, much less than 100. Maybe even in combination with immunotherapy.
The initial «soc» BAT protocole based on T Cypionat on a 28 days schedule has some limitations, the T high is achieved once and T low is to high, probably approx 200 ng/dl. Denmeade is running trials involving Enzalutamide in order to have a T low under castration level, 50 ng/dl.
Using Propionat with a short halflife in smaller doses in the first fortnight of a longer schedule using Enzalutamide to bring the T level effectively down seems to be an optimized BAT.
You achieve both a T high plateau and a low.
It would be very interesting to have Denmeades views if he will reveal them.
I'm going through BAT. Three months now. My PSA started at 40. When I started the therapy, it went down t 13. Now at 9.
I stop hormone therapy ( Orgovyx) for a week after my T shot. I never really did have hot flashes and don't get them now. The T shots tend to make me more alert and more active. That's the only difference I can see. No ups or downs. No hot flashes.
I hope this helps.
After your T shot how long before you restart your Orgovyx? Is it similar to cigafred 's cycles?
I probably shouldn't do this, but my OC here in North Carolina told me to stay on Orgovx wile my original Prostate OC in California suggested I go off it for a week after the T shot. I trust Prostate Oncology in CA, so I go off it for a week after the shot.
I'm kind of guessing that the OC's are just taking their best shot at what might work. So am I.
Similar to Russ506. During many years of standard ADT hot flashes very mild if at all. During six cycles of BAT, initially at two months intervals, then three, I did not notice much difference--hard to separate that from the normal daily ups and downs of ADT.
my hero!
My husband felt great. With the protocol of injections every 28 days, your T never goes to zero so you still feel better than before you started. Going back on Xtandi or Zytiga once your psa spikes can be tough on the body so your MO may suggest a longer wash out phase once psa starts to rise. In my husband's case, he started BAT in Jan 2020 and did 10 cycles of high T. Once BAT failed, he went back on Xtandi which worked for about 10 months. He then restarted BAT which worked for 3 more cycles. At that point he restarted Zytiga which he is currently taking. Zytiga has worked for 3 months causing his psa to drop from 15 to 13 to 9 in December. More tests next week. An important point is that he was on Xtandi and Zytiga back in 2018 until failure in late 2019, so he got over a year from those drugs AFTER they failed the first time. Add on the year he got out of BAT and we are firmly in the camp that BAT can most definitely extend life--with a good QOL! Overall he felt great on T no matter where he was in the cycle and felt lousy on Xtandi. He currently feels lousy on Zytiga. He would have loved to do a 3rd series of BAT cycles but MO said it was too risky after his psa more than doubled in a month on his last cycle. Fortunately, both Xtandi then Zytiga brought his psa down when it spiked after BAT failed.
Thank you for the info. Most helpful !!
Thanks to all who have replied, gives me a better picture of the process.
Unfortunately his BAT days are over. MO thinks it is too risky after his psa more than doubled during his last testosterone cycle. He will probably try Pluvicto after Zytiga fails as long as a psma pet scan shows he is a candidate. He still hasn't had chemo so hopefully the rules will change and allow chemo naive patients to have it.
the standard (original) BAT protocol with T-cypionate 400mg once a month and continuous ADT never allows for full castrate testosterone levels. Half life of the cypionate is 6-7 days so it is not gone before the next shot regardless of ADT. So it is a weak strategy for alternating very high T levels 1000-1500 total T) with castrate (<20). It takes at least 5 weeks to get to castrate and this is marked by return of hot flushes etc.
So many like myself who are on modified or long cycle BAT use topical testosterone gel for the last few weeks of high T which is gone within a few days of stopping. Then use Orgovyx for the time of castrate T, to prevent gonadal testosterone return. It does nothing during the high T phase because the testosterone is extrinsic, not testicular.
My chosen regimen right now is 3 months of very high T (T-cyp 400 every two weeks) with last two weeks the cypionate replaced with T-gel. Then 4 weeks fully castrate on Orgovyx. There is one clinical trial called extreme BAT (ex-BAT) that uses a second month on enzalutamide I believe, after a single shot of T-cypionate. A step in the right direction IMO. But still not yet for HSPC. Applications are expanding and more are using it outside of clinical trials.
Smurtaw is correct. Excellent-BAT trial uses darolutamide, not enzalutamide on the second month of cycles. Better choice.
Ex-BAT not “Excellent “ . Though it may be. 😆
Thanks for the info.
I have two Oncologists. One in North Carolina and One in California. I'm following the advise of Prostate Oncology Specialists in CA, while the one in NC does the grunt work for BAT.
At 74, I find that if I get too involved in my PC treatment, I loose concentration on living the best life I can. I'm Going to die. There is no question about that. The only real questions are, how and when. Having a stroke about 5 years ago made me realize that I have no control over when. As to how, fate will decide that. I will only get involved from a high level.
BAT
Looking for BAT Oncologist.
Bipolar Androgen Therapy (BAT)
BAT therapy - NIH article
