Could I try BAT to restore sensitivity to previously used antiandrogen treatments.

[Islandboy2021]

I failed Abiraterone and SOC doesn't allow the switch to Enzalutamide. I was reading on the use of BAT to resensitize mCRPC. Would this be a therapy that could work or is it too late now that I have failed. I know its not SOC but I am running out of choices and looking for some clarity. Its basically impossible to have these conversations with the Oncologist. Once I finish Radium 223 then I am only offered chemotherapy at this point.

[Tall_Allen]

Chemo may restore sensitivity to enzalutamide:

prostatecancer.news/2022/10...

BAT may restore sensitivity, but recent findings have shown that it only does that in men with high androgen receptor (AR) activity. Only about ⅓ of CRPC men have high AR activity, and I think the only way to test for it is to join a clinical trial at Johns Hopkins.

ncbi.nlm.nih.gov/pmc/articl...

jci.org/articles/view/16239...

Here's such a clinical trial:

classic.clinicaltrials.gov/...

[Islandboy2021 in reply to Tall_Allen]

I have only had abiraterone and failed after a few months. I couldn’t switch to enzalutamide with SOC. If I do chemo again could I then start enzalutamide after and see if it works.

[Tall_Allen in reply to Islandboy2021]

Enzalutamide probably wouldn't work for long if you tried it now. What the PRESIDE trial tells us is that concurrent use of docetaxel keeps it working even after it has failed.

[Islandboy2021 in reply to Tall_Allen]

This trial is what I am looking for and I meet the criteria. Do you know if they accept foreign patients. I am Canadian eh.

Thanks for the invaluable information.

[Tall_Allen in reply to Islandboy2021]

LOL@eh. Yes, all clinical trials in the US accept foreign patients. They might require you to be available for monthly shots and tests, however. Ask them.

[Tall_Allen in reply to Tall_Allen]

Are you in Vancouver by any chance?

[Islandboy2021 in reply to Tall_Allen]

Vancouver Island a ferry trip from Vancouver. Not a problem going there from where I live.

[Tall_Allen in reply to Islandboy2021]

Vancouver Island is so beautiful! The reason I asked is that Michael Schweizer is an MO at UWashington Seattle. He was part of the group at Johns Hopkins who started exploring BAT. You may want to talk to him about duplicating that clinical trial on a per protocol basis.

[Islandboy2021 in reply to Tall_Allen]

Great information. Years ago I was involved in a family study at the Fred Hutchinson Cancer Center in Seattle. I will reach out to Dr. Schweizer.

[dhccpa in reply to Islandboy2021]

Awesome place from end to end. Consumed a few Nanaimo bars along the way.

[Mw921000000]

Are you eligible for any clinical trials? Getting a genetic test can show if you have any mutations which depending could open you up to some possible clinical trials before going to chemo. I’m still doing research but Some trials don’t require prior chemo. My dad is also castrate resistant. We are giving Arbiraterone another try (it never failed, was just intolerable by the liver). His doc thinks it’s worth a shot. I’m not sure what the plan is going forward once it fails. We are saving chemo for dead last.

[Ramp7]

I am attempting just what you mention in your question. I was an initial responder to BAT for a while. PSA started to go up slowly. Instead of Enzalutamide I have employed Darolutamide. Next a traditional BAT sequence to see if HSPC may be achieved. With my conversation with Dr. Denmeade, yes this can be achieved, and how many times we just don't know.

[MateoBeach]

you need an MO who is willing to consider all options and not just SOC. You could try BAT and very quickly see if it works for you. Stop if it does not. Be proactive.

[PCaWarrior]

You need to be on top of BAT if you try it. Approx 1/3rd of men have a good response. 1/3rd neutral. And 1/3rd poor. PSMA scans and PSA measurements and MO oversight are important. The poor category needs to cut off BAT early.

RESTORE and many other trials and studies show around a 70% resensitization rate to Xtandi. Sartor thinks that all ARSIs should be the same (Xtandi, Nubeqa, Erleada). Denmeade thinks that resensitization can occur repeatedly and has a trial in progress to determine.

The resensitization rate is far higher than the unproven need for a high AR activity score (the ARmw score is an example of curve fitting). Regardless of this analytical fallacy, the resensitization rate is over double the 1/3rd good response to the primary therapy (BAT).

In addition, the side effects are fantastic. What man wouldn't want testosterone?

[j-o-h-n]

"Its basically impossible to have these conversations with the Oncologist"

The Greek word “oncos,” means swelling..........Tell him/her if s/he would like a oncos lip to help having these conversations....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 10/02/2023 5:26 PM DST