Brief history. Diagnosed in July 2020 with oligometastatic PC with PSA 1,600… picked at 13,000+ after biopsy, Gleason 8.
One previous bone femur lesion ( succesfuly treated by SBRT and 3 pelvic lymphodes (succesfuly treated by Lu-177). Discordance and previous existence of FDG+/PSMA- lesions.
Volume of prostate 800+ml at diagnosis (no mistake here), now 16 ml.
No surgery or external radiation to prostate, however transurethral HIFU and TACE (chemoembolization of the prostate with Taxotere) in 2020-2021. SBRT to femur lesion, 5 Lu-177 infusions in 2022-2023. Mono with 50 mg Casodex for six months in 2020-2021 (failed after 6 months). 2021-2023 twice 3 months on Orgovyx and once 3 months on Luppron between them 4-5 months no ADT periods, testosterone always recovers fast to normal range 450-600 after stopping ADT. Last PSA one month ago 0.07, testosterone 10. Hormone sensitive.
Currently from January and till August 2023 will be on Orgovyx and Proscar 5mg, Cabergoline 0.25 mg once a week. Also, Metformin and statin for PC.
In July 2023 will be 12 fractions of Carbon Ion external radiation to prostate. Generally, if no treatments at all PSA doubling time is very short – around 3.5 weeks (which should be taking into consideration while developing BAT protocol). Always have high estrogen when normal testosterone, so that should be controlled during SPT. Bespoke BAT will start in August, that month is set in stone. Now I need help developing BAT protocol using mainly cypionate (as propionate might be difficult to obtain or carry with me everywhere I travel), but propionate might be considered also at least for some periods of time.
So far, my views (suggestions and advises of course very welcome):
1. 17th of June planning to add to Orgovyx and Proscar (that I’m taking currently taking) Nubeqa and take Nubeqa till end of carbon Ion treatments to the prostate, that should end on 24th of July. 6 weeks on Nubeqa mostly to increase radiation effectiveness plus to better prime cancer cells for testosterone injection, I’m not planning to use Nubeqa for BAT or otherwise for a while after that. Stop Proscar and Nubeqa on 25th of June. Washout period Nubeqa and Proscar for for 7 days after that.
2. 1st of August to start modified BAT. Stop Orgovyx on 1st of August and Inject testosterone cypionate on 1st of August 400mg, then after one week follow with 200mg of cypionate injection. Start on 1st of August Letrazole 0.625mg twice a week, Cabergoline 0.25mg increase from once a week to twice a week.
3. 21st of August resume Orgovyx and Proscar till testosterone drops below 10 and then PSA drops to the same or lower level that was before first testosterone injection, stop Letrazole 2 weeks after restarting Orgovyx, continue cabergoline 0.25mg once a week while on Orgovyx. Then stop Proscar and 7 days after that stop Orgovyx as well and start injecting testosterone cypionate the same way, repeat one more the same circle and evaluate the results.
After BAT protocol is developed, I have MO to adjust it if necessary and appeals to me and then support it.
Thank you!
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