I have been on Lupron and Abi since May 2022 and in March 2024 Psa bottomed out at 1.02 and immediately started climbing to where it is now at 6.74. My previous MO, who is now retired, said Xtandi would be next treatment. New MO says chemo because I am still strong and it is needed before Pluvitico which he says is a great drug. I am interested in gaining knowledge about se and whether or not it was effective for you. I would also like to know if you did BAT on your own or under a doctors care. My Uro is ok with my seeking info on BAT but MO is against it because it is not approved. I live 90 min drive from JHU wher Dr Denmeade is and where I can be tested to see if I am a candidate. My Uro is a friend of Denmeade and still teaches at JHU one day a week so I feel confident trusting him to guide me through this. As I said, I am gathering info at present and would only proceed if testing shows a possible benefit. Thanks and God bless, Gary.
Experience with BAT: I have been on... - Advanced Prostate...
Experience with BAT
my lay reaction is why would you consider BAT with rising psa? isnt it the kind of thing started off during undetectable psa so one takes a holiday from the adt, hopes psa stays flat, then re-initiates when it rises? rinse repeat?
The answer to your question is as a cancer patient I will consider everything and choose the treatments with the most benefits and highest QOL.
It isn’t what you just described. You described IADT. BAT kills cancer cells by hitting it with a high amount of T after the cancer has adapted to a low T environment. It can also resensitize the cancer to Xtandi or make it more effective if going on it for the first time.
oh, yeah. you are right of course.
I believe one can start BAT when ADT Lupron/Firmagan) starts to fail. At least in the BAT patient guide Denmeade mentioned that possibility (I think, but it's been a year since I read it. Small section toward the end).
I asked my MO about T supplementation and because my case is advanced very high risk, the answer is a flat no-go.
My MO refuses at this point because it is not yet approved. I reminded him that the drug I am now taking wasn’t approved when the first patients started on it. My Uro will be the one to treat me with BAT if in fact the testing shows I’d benefit and I decide to give it a try.
Might as well explore it.
Have you read the patient's guide to BAT?
onlinelibrary.wiley.com/doi...
The test they've developed is based on genetic mutations so if they think you qualify it seems like it would be worth trying.
One thing I think they've pretty much determined is that Xtandi directly after Abi is generally ineffective. Xtandi after BAT is much more effective, even if BAT itself wasn't. I can dig out the links on the trials/info if you can't find them.
Thanks but I’ve read the info and watched the videos. I have a urologist I trust as much as any doctor I have ever had and was a Doctor for several years at JH with Denmeade.
Late to the party as usual but will simply mention my *personally guided, i.e. NO Professional Medical input, HSPCa BAT of sorts experience beginning in 2015 with surgical Castration instead of Urologist's insistence of using ADT DRUGS due to my GL10 diagnoses resolved by having the right half of prostate cryoablation of the easily palpable tumor + 1 in situ injection of NOT FDA Approved Keytruda+Opdivo+Yervoy (1st experimental individual), + IRE of lesser GL6/7 in left half of prostate ++++ beginning bi-weekly 200mg Cypionate injections.
NOTE - T ≥ 1,600ng/dL following injection and down to T ≤ 500ng/dL before next injection.
Followed PSA fluctuations then in 2018 rapid doubling having an Axumin Scan showing 3 spots in remaining left half of prostate biopsied at 3+3 AND 3+4 in not previous locations. STOPPED Cypionate and had IRE to remove spots. PSA normalized and began Cypionate again.
2020 had unexpected doubling of PSA so stopped Cypionate and had PYLARIFY Scan PLUS a 3TmpMRI both showing clear. Began Cypionate again.
2023 PSA begins increasing to 12ng/mL (original diagnosis was at 14+ng/mL. Immediately stopped Cypionate and scheduled biopsy following another PSMA PET/CT but soonest was a couple of months later. PSA prior to biopsy was dropping and biopsy yielded 3 new spots in left prostate as being 3+3. Dr. and I discussed options and I chose with his agreement Watchful Waiting. Currently PSA = .04ng/mL and T ≤ 2.5ng/dL still off Cypionate but following next PSA later this month if stable will begin Cypionate again to raise T back to fluctuating levels.
NOTE - if PSA rises as expected I will STOP Cypionate to T ≤ 2.5ng/dL again expecting reduction in PSA and then resume Cypionate.
Another NOTE - actual Medically Guided BAT is directed to CRPCa and NOT HSPCa.
The above is a 74yo's layman's strange approach to MY PCa so please excuse my thinking. Good Luck
No excuse needed my friend. I did everything possible on my own for over 20 years to avoid the disease effects of treatment.
If it worked for you, it worked for you. Did you spring for any of it (other than Cyp) out of pocket?
“We are each an experiment of one. A unique, never-to-be repeated event.” by Dr. George Sheehan -- Cardiologist, Athlete, Author and died from PCa.
^^^^^ the above quote is spot on for each of us as some have good outcomes and others not.
Doctor's fees - $$
Immuno drugs - $$, Cypionate - $$
Testing - $$
It’s odd you should mention that now. My Uro and I just discussed that. My previous Uro told me of a patient who had aRP and it failed. Uro recommended RT which patient refused. Patient returns a few years later with bone pain and a Psa of 7000plus. Patient gets a three mo Lupron injection and psa drops to 4. Gets second injection and Psa drops to 1 and all pain gone. Patient refuses further treatment and doc doesn’t see him again until he returns several years later with hip pain. Doc checks things out only to find no cancer, just a hip that needs replaced. Guy gets new hip and is doing fine. Doc says that’s a one in a thousand case. I look at my new Uro and ask him if that is a one in a thousand or a one in one case. He comments, “great observation but we’ll never know because nobody has the courage to find out.”
Don't do BAT on your own-- it is dangerous.
Thanks TA. I am only gathering info at present and will not proceed without testing at JH. As I said my Uro is a friend of Denmeade and I live less than 90 min drive from JH. I meet their first two requirements which is no pain and no urinary symptoms. My Uro is going to discuss this with my MO and I’ll proceed after I get all opinions. Pretty sure both think I need another liquid biopsy and genetic testing again.
JH has a biochemical test now.
It seems it is not possible for unconnected outsiders to access this test?
Right.
I see you live near Baltimore. I live near Seattle and there is a MO at Fred Hutch who coined the term in 2015 and speaks regularly about it at the Pacific NW Prostate Cancer Conference.
fredhutch.org/en/provider-d...
This is his presentation at the 2022 conference: youtu.be/-0TJ71KWURU?si=86X...
I have not consulted with Dr Schweizer but I have him on deck in case/when I get hormone resistant.
Why not just go see Denmeade?
Since I live in So Cal I tried to connect with Denmeade with consultations via Zoom but that goes against their policy. Patients must go to Hopkins in person. Now on BAT with Dorf at City of Hope.
Hi SViking. I am also Dr. Dorf's patient. Pending Pet scan esults next week, Dr. Dorff, has ecommends BAT.
How long have you been on BAT? Are you happy with your progress so far?
At the two week mark from testosterone injection my testosterone was only 100. I actually felt pretty crappy the first two weeks until the testosterone wore off. PSA doubled from 12 to 24. But no bone pain whatsoever.
I will if my Uro can get me an appointment.
It's easy to get an appointment. Just call and set it up.
I ask; Why did you & your MO wait until your osa was so high to start Andy treatments?When my PSA quadrupled from 0.24 to 1.07 I was immediately put back on Lupron/Nubeqa.
Not everyone treats Psa. Some people treat symptoms in an effort to maintain a QOL.
That is their choice of course.
Skip your MO and have your Uro guide you through a trial of BAT in consultation with Denmeade. The only way to know if you aare a favorable responder is to try it as a test for a few months. Also get a PSMA PET scan to see if you are oligometastatic with SBRT targetable mets(unless you already know). MB
From what I understand the test is to determine the amount of ar receptors. If the number per cell is high then BAT would be the choice but if they are low then Xtandi would be the choice and revisit the BAT option after Xtandi fails.
It actually seems to be a little more complicated than that:
Oh it is, I was trying for the abbreviated version.😂
Sounds like a good plan.
We did BAT w Dr. Denmeade. Cancer was very advanced in bones at the time and experienced that initial pain that is warned about...it was debilitating but goesxaway in a few days (be ready w palliative measures and to be knocked out for a day or 2, but if bone mets aren't pervasive, might not have this problem at all. And it's only after the first shot). Again, we did this after marrow involvement so very advanced, but it probably got us 6 months we wouldn't have had (he'd been given a prognosis of months and lived for a year after) . We didn't get the joy of testosterone restoration (again...very advanced disease) but others do get a brief reprieve. On a side note, Dr. Denmeade is a pleasure to work with.
❤️
Thank you.
to FightingforSmith
You have my (and our members) sincerest condolences in Smith's losing his battle with this vicious disease we call Prostate Cancer. May he forever Rest in Peace.
j-o-h-n
I am 17 months in on salvage ADT after RALP and radiation headed to 2 yrs on ADT so I cannot directly answer your question. However, my father in law never really responded to Zytiga but has responded well to Xtandi for several years (Scans stable and PSA stable at 4'ish) now in spite of having mets throughout bones. When his oncologist told him to stop the Zytiga he stopped the prednizone cold turkey as well and he went through hell for a few days. You need to taper off the prednizone. Good luck
One man's experience can be found on Amazon. It's free.
Adaptive Bipolar Androgen Therapy (BAT) for Prostate Cancer Kindle Edition
by Russ Hollyer (Author) Format: Kindle Edition
If you have the choice to do B.A.T. Do not hesitate. You’ll thank me later
You want to consider it before your psa rises past 24, the sooner you start the longer you can go and the most effective it will be.
Plenty of info on it now to search. I did mine under trial at Yale. I would do it again in a heartbeat.
Good luck.
Thank you, this is what I am looking for. God bless.
p.s. - just a fyi, with my T ≥ 1,600ng/dL, I actually did not FEEL like a stud or younger guy. Go Figure
I did not feel well either after my 400 mg testosterone injection two weeks ago. No appetite, libido, physical strength, or stamina. Hoping that will change down the road.
I am wondering why the specific number of 24 for Psa.
I think it’s less about the psa as it is about how bothersome the tumors are. From my experience the die off or other is very painful after the first cycle. I’d imagine the bigger the tumors at start, the more painful it will be and the less time they will keep you on the trial.
This is just my educated guess.
Studies show if you have a p53 mutation it tends to work more favorably.
Same for BRCA2 mutation if I am not mistaken
*** Taken from Perplexity AI
BAT and DNA Damage
BAT has shown promise in treating castration-resistant prostate cancer (CRPC). Some research suggests that BAT may be particularly effective in patients with DNA repair defects:
BAT can induce DNA damage in prostate cancer cells
Patients with DNA repair mutations may derive more durable clinical benefit from BAT1
Given that BRCA2 is involved in DNA repair, it's possible that patients with BRCA2 mutations could respond more favorably to BAT. However, more research is needed to confirm this hypothesis.
Hi Gary, I decided to skip the Lupron and will be taking a daily pill of Orgovyx along with the proton Radiation. My PSA hovers between 0.3 and 0.4 and the PET scan showed a small suspicious growth in my lymph node in the prostate area. My doc feels confident that he can zap it with Luoron therapy and Proton radiation. I'm uncomfortable with potential side effects of Lupron so he's going with the Orgovyx pill and Proton Radiation. Wishing you well. Ron
Thanks for the reply. I too was very concerned with all of the horror stories online which is one of the reasons I put it off. Truth is very minimal side effects for me. No libido of course, some fatigue, very mild hot flashes lasting under a minute and very few. Bp is great as well as liver and glucose. I take 2800mg of curcumin and 400mg of magnesium glycinate daily. If you decide on trying these I highly recommend you research them, consult your doctor first and monitor bp daily. Both of these lower bp. Thanks again and God bless,Gary
Thanks Gary. I appreciate your opinions 
BAT and Denmeade are a good option. 30% respond well to BAT. In a trial you will be doing constant ADT, in your case lupron. They will cycle you on and off on testosterone cypionate one injection a month. There are a few trials going on with different protocols.
I do my own version of BAT you can look up my posts on “fight Prostate Cancer” group.
Here is a list via chatGpt to look into.
Bipolar Androgen Therapy (BAT) is an emerging treatment strategy for prostate cancer that involves alternating between low and high testosterone levels to disrupt cancer cell growth. Several clinical trials are currently investigating the efficacy and safety of BAT, both as a standalone treatment and in combination with other therapies. Below is a list of ongoing BAT trials:
1. STEP-UP Trial (NCT04363164): This trial involves patients with metastatic castration-resistant prostate cancer who have received prior treatment with abiraterone. Participants are randomized into three groups to evaluate the effectiveness of BAT in this setting. 
2. BAT in Combination with Sipuleucel-T (NCI-2024-00050): A Phase II trial assessing the combination of BAT with sipuleucel-T, an immunotherapy, for treating metastatic castration-resistant prostate cancer. The study aims to determine the safety and efficacy of this combination therapy. 
3. APEX Trial: This innovative trial combines BAT with DFMO, an oral drug that blocks the production of key metabolites required for prostate cancer cell growth and survival. The trial is currently open for patient accrual. 
4. BAT to Restore Sensitivity to Androgen Deprivation Therapy (NCI-2024-01390): A Phase I trial testing whether BAT can restore sensitivity to androgen deprivation therapy in patients with metastatic castration-resistant prostate cancer. The study evaluates changes in androgen receptor sensitivity, side effects, and effectiveness of BAT. 
5. BAT and Radium-223 for Metastatic Castration-Resistant Prostate Cancer (NCI-2024-08362): This trial investigates the combination of BAT with radium-223, a radiopharmaceutical, to assess their combined effect on tumor cells in patients with metastatic castration-resistant prostate cancer. 
6. BAT and Nivolumab Combination (Dana-Farber Cancer Institute): A study exploring the combination of BAT with nivolumab, an immune checkpoint inhibitor, in patients with metastatic castration-resistant prostate cancer. The trial aims to determine the safety and efficacy of this combination therapy. 
7. BAT with Sipuleucel-T (Yale Medicine): An open-label, single-arm Phase II study evaluating BAT in combination with sipuleucel-T to determine the immune response in patients with metastatic castration-resistant prostate cancer. 
These trials are actively recruiting or ongoing and represent the current efforts to explore the potential of BAT in prostate cancer treatment. For more detailed information or participation inquiries, please refer to the respective trial identifiers or contact the institutions conducting the studies.
Thanks for the info. I see my MO on Dec.11 and will see what he has to say. My Uro is good with it but wanted to talk with MO first. As I said my Uro and Denmeade are friends so that should help but since my MO refused because it isn’t FDA approved that could cause an issue. I may have to find a different MO.
But if it is a clinical trial he really can’t say no. Besides your the boss
thanks for the information. I dm following your your footsteps. My psa dropped to .02 for last few months so after 5 months I am doing well in terms of the abirterone/pred/lupron but my quality of life is dropping like a rock.
Keep us updated and glad your exploring options. Sadly, there have not been enough of us on any of these last stage treatments to know which is best. We are Guinea pigs at best in this shell game.
LIVE LARGE MY FRIEND AND LEAVE NO STONE UNTURNED AS EVERY HOUR NOW COUNTS!
Calling all BAT-men ...
BAT Question
BAT & Abiraterone / Enzalutamide resensitization
