BAT??

[JolleySprings]

Is “BAT” treatment a consideration for those with Castrate Resistant status??

[PCaWarrior]

CRPC does not disqualify you. CRPC is a requirement for conventional BAT.

[Ramp7]

I know of people that are doing BAT that are castrate like myself and some that are still Hormone sensitive that finding BAT effective. urotoday.com/video-lectures...

[KocoPr in reply to Ramp7]

The only thing is they didn’t broach the subject of hormone sensitive with BAT, or only 1/3 of CRPC patients responded positively.

I understand it is a quick overview interview of BAT so if people are interested they can certainly research the loads of information on it.

[JolleySprings in reply to KocoPr]

This is true per my husband’s Oncologist. He said the results were not very promising for CRPC.

[Nfler in reply to JolleySprings]

Read a study yesterday that bat was just as effective as enzalutamide and if you have bat first then Enza was more effective than the other way around, with a whole lot less side effects, much better qol…

[JolleySprings in reply to Nfler]

Thanks!! Do you mind referencing the study you are referring too??

[Ramp7]

There are many details left out here. Denmeade uses Cypionate Testosterone, very long half life. Propionate has a short half life which some believe may shock the cancer more effectively going from High T to Low.

[PCaWarrior in reply to Ramp7]

It's early but results so far support a fast-acting testosterone like propionate.

[JolleySprings in reply to PCaWarrior]

My husband has such a rare mutation… CDK12 … which i think is the greatest concern. How it may react differently than typical PC … cells etc.

Everything is a gamble in these type trials etc.

[KocoPr in reply to JolleySprings]

CDK12 is a DNA repair gene and BAT with propianate should work. The good thing about propianate is you can adjust your high T cycle to as little as a few dsys.

So starting out he wouldn’t be constrained to month by month injections.

Propianate you injecting every other day and has a fast drop off of T 3 days it’s gone.

[JolleySprings in reply to KocoPr]

My husband has zero T now with a 5.4 PSA and clear scans as of Oct. Thus far, at 7!years no metastasis but PSA rising.

[JolleySprings]

He is not a vet! But, I’d be interested to know how that trial is going!

[MateoBeach]

Consider that it is quite easy and inexpensive to do an individual test of BAT for an individual patient with community oncologists. Standard (original) BAT just requires one shot (400mg) of testosterone cypionate every 28 days and then monitoring with lab tests, such as PSA and testosterone one week after injection (response to the high-T phase) then again just before the next injection. This latter is the most important: If PSA rises more than 25% from baseline to end of BAT cycle, and especially if it progressively rises, then one is consideereed an "unfavorable responder" and should not continue it. Almost always one returns to baseline and no harm (progression) is evident on scans.

If one is a favorable responder for 2-3 cycles of BAT, then one can consider a more carefully crafted regimen of modified BAT. This will maintain more even high levels of testosterone (>1000 mg/dL) for 2, 4, 8 or even 12 weeks.Testosterone propionate is particularly well suited for this, or topical T-gel.

Then a completely castrate T phase using ADT and perhaps adding an ARSI drug such as darolutamide, again for 2, 4 or 8 weeks depending upon how aggressive the PCa is. I believe cycle length should be informed by cancer replication rates (PSADT). However this is and experimental and non SOC undertaking. So we have to accept risks of the unknown and be prepared to modify or discontinue when needed.

BAT was first tried in trials for mCRPC for ethical reason. However, it is becoming evident that it is perhaps even more often effective in HSPC.. This was suggested from the BATMAN trial and is being further demonstrated in informal compiling of personal experiences outside of trials. A definitive trial of BAT in HSPC has yet to be done. Paul/MB

[pca2004 in reply to MateoBeach]

Paul,

It's a crazy situation; Denmeade targeting CRPC men - with mixed results - when he could be testing a version of BAT on men who are not yet castrate resistant - with the aim of delaying or preventing CRPC. Ideally, treatment would begin at the initiation of ADT in metastatic hormone sensitive men imo.

But men with CRPC are short of options & I can see why the focus might be on CRPC. And study accrual is not an issue in that population. lol

CRPC is treatment-induced and men who are aware of this dread the day when progression inevitably occurs. There is no unsurmountable obstacle to prevent someone from using testosterone periodically, in an attempt to roll back adaptations and extend the life of ADT. IMO - not medical advice.

BAT, as currently defined, requires continuous ADT. This can mislead - there is no castrate phase. By eliminating patient-produced testosterone, Denmeade is aiming for a 28-day high of ~2,000 ng/dL and a near castrate low.

It makes no sense for there to be a castrate phase for men who are resistant to castration. That is not the case for hormone-sensitive men.

With the BATMAN study (2016) [1], men started with 6 months of ADT, seemingly to bring PSA into the required range (50%, but disappointing to me.}

I'm assuming that "18" months does not include the 6-month prequel. If so, the men would have been on ADT for 24 months. The boilerplate preamble in many old studies has it that almost all men will fail ADT within 18-24 months. So 6+18 months makes perfect sense. Classic ADT plus Abi, Enza, etc, etc.) extends that somewhat, and a longer study duration might be warranted in such scenarios.

Note that, as stated above, ADT during a BATMAN cycle is for study convenience.

{For many years I followed a protocol of 3 months of testosterone at ~1,000 ng/dL alternating with 3 months of ADT.}

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/273...

[MateoBeach in reply to pca2004]

Many good years. And may you have many more.