I was on Xtandi as part of a clinical trial at NIH and after 2 years my PSA started climbing and PSMA scan showed metastasis in abdominal lymph nodes and supraclavicular node. Biopsy of the abdominal nodes wasn’t possible but biopsy of the supraclavicular node was inconclusive. However , this knocked me out of the trial. I then started Nubeqa which has kept the PSA at bay for another 2 years but PSA got up to 14 and PSMA scan showed some advancement of the mets in the abdominal nodes. I had immunotherapy (Provenge) which didn’t really do much and my PSA remained 14. My MO recommended adding Orgovyx to the Nubeqa and PSA went down to 6. I hate the sarcopenia and weakness and proposed trying BAT. My MO has had me stop Nubeqa for 4 weeks but stay on Orgovyx. During the four weeks off Nubeqa I’m getting weekly testosterone injections and rechecking T and PSA. I’m concerned that after 2 weeks my PSA is back to 14. Is BAT not working for me or is it too soon to tell?
Thanks
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AllenMarco
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When Morgentaler tried supraphysiologic doses of T, patients died. I think BAT can be used in some patients, but you are clearly not the one.
Johns Hopkins is trying to improve patient selection for BAT, and they've made some progress. They found that men with high androgen receptor activity may respond better. But if you aren't being treated at Johns Hopkins, they can't tell you that. In fact, what they learned last year was that Xtandi (but not Zytiga or other advanced antiandrogens) prevents acquired resistance to T because it upregulates the AR while it inhibits it. So your previous treatment with Nubeqa was not helpful, as Xtandi might have been.
BAT really should not be attempted outside of a clinical trial, preferably backed by Johns Hopkins excellent labs.
Testosterone every week is not the BAT protocol. BAT is one dose of testosterone cyprionate 400 mg every 4 or 6 weeks and your testosterone should reach very high levels, at least over 1000 and then decline in 4 or 6 weeks to castrate levels.
Might my MO been wanting to see my response before giving me such a long acting injection? I don’t know what to do from here. I presume back on the Orgovyx and Nubeqa? Does the rebound of the PSA indicate a failed attempt?
BAT to work needs that the testosterone reach very high levels. PSA may increase because there is a higher metabolic activity and not necessarily a pregression of the cancer.
Consider to request radiologic studies to see what is happening with your tumor load.
Denmeade and other BAT experts have pointed out that the initial exposure to high-T quite often results in a PSA increase that is NOT indicative of PC progression. It is just what T does: causes an increase PSA expression, regardless of what the PC cells themselves are doing.
There is no way to know if BAT is working or not working in just a few weeks. It takes at least a few months, and even then, PSA is not the best proxy to know PC is progressing or regressing at that point. One must consider scans, symptoms, and other markers like Alk Phos. (If bone mets are progressing, ALP will likely be rising.)
Thank you. I need to have a discussion with my MO. From what I’ve read the T needs to reach supraphysiologic levels to have the results of BAT and I didn’t understand why my doctor would have me get an injection of 100 mg/week instead of 400 mg/mo.
I intend to do a detailed post, but we ran into a bump in the road... my mets caused some serious nerve compression for some facial nerves and we had to address that with radiation treatment and high-dose dex, and my MO wanted to delay a new treatment until after that (one fear being the T might be inflammatory or otherwise interfere adversely with the radiation). Talking to him this week about when we kick off the T.
Thanks for asking!
I had both BRCA2 and ATM, a SBS3 HRD profile. When PSA started to rise after 18 months on Olaparib, it was time to try a new theraphy. Hopefully I will have a ctDNA biopsy in the near future, revealing mutations and TMB. My PSMA and FDG scans were negative, so lu177 was ruled out.
My MO tried to convince me to try Olaparib before BAT, but I am already very anemic with low platelets, too. Seemed too risky to me. The BAT may actually improve things.
Did you become anemic with olaparib, or have any other of the possible bad side effects?
Glad keto is going well... how long have you been on?
No, Olaparib in 3/4 dose was not bad at all, platelets remained the same. Enza was much worse! BAT makes you feel restored to normal, not sick at all.😅 Hemoglobin around 13 in the whole period.
Good luck.... when I did a few years back I was amazed at how great I started feeling about a month in.
Yes, unfortunately. On the other hand, having biallelic BRCA2 the PARPi Olaparib worked for 18 months, the cells could not repair DSB., A pro for BAT as it is supposed to induce DSB. Being HRD or having TP53 or both is a pro.
…see if this podcast can help. Go to Min 14:23 where history of BAT treatment starts. Talks about two items that may interest you, Saturation theory n the Inverted U. Seems that most benefit from BAT but PSA rise and it’s acceptance is part of the gamble. What I note is that in the end the outcomes appear to be similar. QOL improvement must be enough to justify this risk or else it may be too much to bear. I will be publishing my detailed review of the podcast next week. It’s a ‘tour de force’ on TTh (TET therapy) n TrT (TET replacement). Also note at Min 25:45 that the 1 st randomized study w 6000 men was due to be published June, 2022; TRAVERSE study. Can’t find it yet but looking. Good luck.
From an MD that is a guru of natural health at Langone Medical Center in NYC. Dr. Geo Espinosa ( I recommend that every man here follow him)- and someone that in addition to medical intervention, my father (and mother have had 5 telemedical calls with) over the last 5 years -
way too much importance is put on the "PSA number" that is only a small part of the entire prostate cancer equation.
This is all I will say about this topic.
Please check out Dr. Geo. He is an amazing man. Human. Doctor. And, health advocate that does so much more than prescribe medication. He values each persons quality of life...and has given so much hope to my parents.
My dad is 87. Is on the SPLASH trial. Also recieved radiation to lesions in his spine. And is an ASS KICKER that loves life and looks forward to tomorrow - despite battling very hard.
Sending love, hope and healing prayers to you all,
Dawn
God bless your father! He’s blessed already with you ! 🙏❤️❤️❤️❤️❤️
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To the brains of this forum ,a question about PET/CT PSMA result
PSMAddition Phase 1/2 Results?
To ARi or not to ARi, that is the question
Time for a vacation, but worried about IADT
PSA going in wrong direction
