(... that's you, Russ!)
I am about to begin BAT with a new MO (who works in MA and NH), and am looking for some input from forum members. My MO has an existing contact at Johns Hopkins that he's consulted, but is not (yet) in direct contact with anyone from Denmeade's group so far as I know.
A little background...
In spring 2022, had a PSA rise while on ADT + abi + pred, after about 8 months of lower PSA and ALP. (I have extensive "superscan" skeletal bone mets, ALP was over 1000.) Began Pluvicto trial with Dana Farber, and after an initial PSA drop it rose through the summer/fall of 2022. Scans showed what was termed "stable disease" but some new mets appeared.
After my fifth infusion (late Oct), I had extreme fatigue and my mild anemia accelerated to "moderate" levels and I quit the trial before my final infusion. I believe I also had some kind of post-COVID malaise/virus and felt increasingly weak, depressed and unwell through Nov and Dec. That, along with non-cancer back pain, led me to quit my job and go on my wife's insurance.
Being ill, I missed my 3-mo Lupron shot that was due in late Nov. With the insurance switch happening Jan 1, I decided to move my care closer to home and resume with a new MO. (Dana Farber will not do BAT except in clinical trial.) We decided at our first appt. on 1/6 that since I still had some abi on hand, I could resume that along with a short course of high-dose dex to get T back down asap, and schedule a Lupron shot. In addition, my anemia had rapidly gone "moderate" to "severe" and a transfusion was needed.
First question: having received my Eligard shot yesterday (Jan 19), and discontinued abi, what would be a reasonable date to get my first dose of high-T? My MO thinks it should be a full four weeks from 1/19, but wouldn't a full month from 1/6 make sense, too?
Technically I was "off" of ADT for about six weeks, but after having a T <4 for over a year I can't imagine my T recovered too much during the month of Dec. Then the abi should have reduced my T, even though abi monotherapy is not considered "ADT." Am I "castrate-enough" to start the high-T by the date of 2/3, if not sooner?
Second question regards the current nature of my PC. Between the cancer and the Lu177, my bone marrow is not producing sufficient red blood cells or platelets. I expect to need another transfusion in a week or two. Is there anything in the literature, or anecdotal, about successes or failures of BAT when bone marrow is involved? Intuitively it seems like a good therapy in this situation since the high-T itself may stimulate some of the needed anti-anemia activity. But if the T works to kill cancer cells as it hopefully will, is there any evidence in BAT-treated men of recovering marrow function after it being compromised by cancer and/or radiation? Or any evidence or reason to think BAT might worsen the anemia (other than if the T stimulates progression instead of slowing it)?
Any input is appreciated, even if just thoughts. I am pretty excited to give this a try, because if it fails to slow progression I hope to at least get a short QoL boost.