BAT and other update

[Bjry]

As others have correctly said, BAT isn't for everyone. In my case my PSA went up from the get go and after about 4 treatment cycles I was pulled from the trial. The primary trial goal totally failed, when I left the trial my metastases were thriving and my PSA rising. The secondary trial goal also failed and unfortunately BAT didn’resensitise past failed treatments. However I don’t regret giving BAT a go - when I enrolled in the trial I was 6 years after diagnosis, enzalutamide had failed, my PSA was high and doubling every few months. BAT was a gamble I was willing to take. Another motivation was that while SOC extended my life, I was also breeding an untreatable strain of metastases that would eventually kill me. Upsetting the cancer's evolutionary path leads to unpredictable outcomes but that was a risk I was also willing to take.

The end of this journey was made clear to me almost from the day of diagnosis. The unknownable factor was how long the journey takes. Where am I now ? I am in my 7th year after diagnosis and have just completed 7 cycles of cabazitaxel which has dampened my rate of PSA progression. My PSA is now 3696 and rising, multiple bone metastases in more bones than I could number, but so far no tumours in my brain, liver bladder etc. Overall then, not totally ‘up shit creek without a paddle’ but not that far away either.

Radium 223 or Lutetium 177 are recommended and seem great options. I’m waiting on treatment cost quotes but early cost estimates look unaffordable. I’m not sure what other options I have but until I get further advice I'm continuing with cabazitaxel. It's not a great choice as I’m sure it’s given me treatment induced macrocytosis and the reduced oxygen has seriously impacted my stamina. However at present I’m pain free and enjoying regular contact with family and friends.

[westobutch123]

Appreciate your detailed update and wishing you the best. I'm earlier in the process but expect to be similar to you in the future.

[Tall_Allen]

Was there a BAT trial in Australia? I know that Peter Mac in Melbourne is on the forefront of radiopharmaceutical development -are there trials you can get on?

[Bjry in reply to Tall_Allen]

BAT trial NCT03522064. Peter Mac recently had a great Phase 1 trial Radium plus Lutetium, unfortunately it closed a while ago. No others running at present.

[Tall_Allen in reply to Bjry]

Thanks. Which DNA repair deficits do you have? The second generation PARP inhibitors may be useful beyond BRCA2. You might qualify for Module 5 of the following that has several sites in Australia:

clinicaltrials.gov/study/NC...

[Bjry in reply to Tall_Allen]

Thanks for your reply. I had germline test done in 2021 with no mutations identified. I then had a tumour biopsy done in August 2024 which found "a varient of potential clinical signifiicance (TIER2C) has been identified in the Ar gene, pH875Y." But tthere are no recommended treatments for patients with this variant.

My PSMAsacan reports "no suspicious activity in the prostate gland". It seems my treatments have saved my prostete gland but not my bones!

[Mascouche]

Not new since its from 2021 but new to me. Just read that when it comes to BAT, those of us with a BRCA2 mutation might have a better response to it. It would be one of the rare times when having a BRCA2 mutation is an advantage rather than an additional burden.

BRCA2 Mutations and BAT Response

Research indicates that patients with BRCA2 mutations who have metastatic castration-resistant prostate cancer (mCRPC) may respond well to BAT:

A retrospective analysis found that all patients who achieved deep PSA responses to BAT harbored pathogenic mutations in TP53 and/or homologous recombination DNA repair (HRD) genes, which includes BRCA2.

The study identified 22 out of 114 (19%) patients with mCRPC who achieved ≥70% PSA reductions upon treatment with BAT.

Potential Mechanisms

The effectiveness of BAT in patients with BRCA2 mutations may be related to:

BAT's ability to induce DNA damage and genomic rearrangements, which could be particularly effective in cells with impaired DNA repair mechanisms.

The rapid cycling of testosterone levels in BAT may exploit vulnerabilities in cancer cells with DNA repair deficiencies.

Clinical Implications

These findings have led to further investigation of BAT in specific patient populations:

A clinical trial (NCT03522064) is examining the role of BAT in mCRPC patients with HRD mutations, including BRCA2.

Another trial (NCT02090114) is studying BAT in mCRPC patients with mutations in TP53, PTEN, or RB1, which are often associated with poor prognosis and may benefit from this approach.

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

[Bjry in reply to Mascouche]

Thanks. It's a shame we don't have this sort of research and advice for every systemic therapy.

[Jac_J]

Your a good Aussie.

I knew that straight after I read ’up shit creek without a paddle’.

All the best for the future mate

[Bjry in reply to Jac_J]

Thanks Jac.

[cancervictim]

Thank you for sharing. Seems people are more likely to post positive news which can bias readers about treatment. My husband considered BAT but cancer so aggressive that the risk seemed great. Is there possibly an Actinium trial? I wish you the very best.

[Maxone73]

Check the Cu67 trial.... urotoday.com/conference-hig... it's an Australian company

[Bjry in reply to Maxone73]

Thanks Maxone,

I am a usually anonymous reader of all of your contributions. I have been following the Cu 67 trial and I have emailed the company to ask why they have no trials in Australia. My guess is that it is share price related - its a very small trial and they may get more bang from positive trial results in the US than results from trials in Australia.