I started my first BAT cycle on 3-12-24, originally designed to last for 32 days. PSA was 0.5 and I injected 50 mg eod of T propionate and .625 mg of letrozole every 3rd day to inhibit conversion of T to E2. Here are my blood test results during the cycle followed by a couple of questions:
3-26-24, drawn 7 hrs after the last of 8 T injections: Total T: 2981 ng/dL (will reduce to ~2100 for 2nd cycle); E2 < 2.0
4-13-23, drawn 18 days after last T injection (32 days total): Total T = 20 ng/dL; PSA = 0.95
4-20-24, drawn 25 days after last T injection (39 days total): Total T = 15 ng/dL; PSA = 0.62 (started 2nd BAT cycle on 4-22-24)
Questions:
1. An additional week of loT was needed for PSA to reach nadir. Is it too early to add an ARSI to the loT cycle? Darolutamide?
2. E2 during hiT measured under 2 pg/mL rather than the expected 10-29 pg/mL. Should I reduce dosing frequency of the AI (currently every 3rd day) or continue with the full dose and wear a low dose E2 patch to bring it up into normal range?
3. I’m scheduled next month for a series of 5 SBRT to the iliac lymph node chain that lit up on a PSMA scan in Jan ‘24. Should BAT be suspended during SBRT?
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Ichthus316
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Your E2 will need adjusting with letrozole. I have been trying to adjust but my E2 still swings more than i want. It would probably be easier to control with E2 patches but it is another variable and i have not done E2 patches. Still working on adjusting letrozole..
You should be doing darolutamide but will need to give it 6 days to clear before T injections.
As far as doing BAT during radiation i am not sure but they both cause DNA double strand breaks so if it was me I would study that more. I think there is plenty information on that.
Thanks, KocoPr. I've been following your case closely for several months as I believe that we both started out on the same pBAT program suggested by Russ. I miss his expert advice. Let's keep in touch to try to fill the void.
Curious what your MO says about it. I mean, are there doctors that are up to date on all this? Or do you tell them what to do basically. And they say, "whatever you say.."
I believe that there are only a handful of MOs around the country who are up to date on BAT and thus qualified to weigh in on these issues. My MO is open minded and is learning about BAT but other than me, has no patients that are doing it. My RO knows nothing about it.
i’ve thought a lot about it, thinking that if I ended up becoming metastatic that I would like to try it. But getting somebody to actually prescribe the regimen and know what they are doing seems very problematic.
BAT requires only testosterone and an aromatase inhibitor such as letrozole to start. If your MO won't prescribe them, they are available from other sources. The only other script that may be needed in the initial cycles is an ARSI such as darolutamide. My MO has already that said he is willing to prescribe that for me. It is important to get up to speed on Denmeade's BAT trials in order to get your MO on board. It he's at all open-minded, he will listen to you and consider the science. It would also be helpful for you to read Russ Hollyer's well-researched book on this subject. Here is a link to it, which is free online:
My local MO was initially reluctant to engage in the topic of BAT. I shared trial study results with him and my own data. He has embraced the concept and supports my efforts. He is CC'd on my correspondence with Sam Denmeade. He shared with me that one of his patients enrolled in a trial study at Dana Farber that included BAT and Provenge, I believe. He had a heart attach and had to drop out of the study but is now hormone sensitive. His PSA is responding.
That is what my MO said when i told him what I am doing. He told me that after several years of being hos patient he has complete faith in me. A few months ago he gave me an A+ for being a great patient who understands his disease.
Good questions Ichthus and welcome to the BAT club. pBAT (T-propionate QOD) is a fine way to maintain SPT levels during that portion of the cycle. I would not worry about the T level being too high with a peak at 3,000. With 24hr half-life it would be around 1500 at 24 hrs and 750 for your next injection. I try to keep mine above 1,000 throughout so use 75-80 mg T-Prop QOD. Higher PSA during this is just expected, as long as it drops to baseline or below during the castrate phase.
That should be easier after the SBRT reduces cancer burden. When I had SBRT 2 years ago I was advised to just keep up my testosterone throughout. No one really knows but I had a very good result (N=1).
I use a 4 week castrate period following a 1 week washout of the T-prop. So 5 weeks total. That is how long it takes for the androgen receptors (AR) to up-level in number and activity in preparation for the next high-t BAT cycle- Taking darolutamide is helpful, particularly during the first 2-3 weeks of low-T castrate cycle to block any residual testosterone. I use it for first 2 weeks of ADT by Orgovyx.
I believe we need to have some estradiol present. The letrozole is excessive and might not be necessary at all. Even though I do 3 months of my SPT cycles I do not use letrozole at all and my E2 has never gone above 18.
Cancer Patient Lab is another good resource for sharing mBAT info and experiences. MB
Hi MB , did you meant to say “I use a 4 week castrate period following a 1 week washout of the T-prop. ”? Did you mean a washout of darolutamide?
Also you stated. “Higher PSA during this is just expected, as long as it drops to baseline or below during the castrate phase.” My PSA has not gone back to baseline but has been rising slightly which is not uncommon on high T. At least it means it is still androgen dependent. Do you agree? Your knowledge and opinion matters.
I just did a whole 30 days of T-prop and PSA climbed to 2.04. I expected this and am doing a month of daro and Orgovyx. I worry more about knocking my cancer to low as it will learn a new pathway to exploit.
Do you stay on Orgovyx through both cycles? If not what is your Orgo schedule? Mine i have been doing it only during castrate cycle cle but am thinking starting it a week before castrate cycle start.
Letrazole: i have been experimenting with a lesser dose than once every three days to about once per week which caused my E2 to rise38. So will try every 5 days next.
Thanks, Paul. I will take your comments into consideration for my next cycle and for my upcoming SBRT. I've been reading your posts for many months now and I value your thoughts and years of experience fighting this battle.
In the 3rd paragraph above you write that "a 4 week castrate period ...is how long it takes for the androgen receptors (AR) to up-level in number and activity in preparation for the next high-t BAT cycle...". Is that independent of the length of the high T cycle?
And is that true across the board or only for a specific subset of men such as yourself?
Are there studies on this question that you could share?
I started out on 15 days hiT, 15 days loT, 30 days for a complete BAT cycle. Is that ineffective? Do you think that I should consider lengthening loT to 28 days? Or should I lengthen both hiT and loT to 28 days?
"I’m scheduled next month for a series of 5 SBRT to the iliac lymph node chain that lit up on a PSMA scan in Jan ‘24. Should BAT be suspended during SBRT?"
(1) Logically, if the bat is weakening your cancer you should keep it up. But complex biological systems often don't share their complex logic.
(2) There is unlikely any peer reviewed research on this. But your bat doc may have some informal clinical observations that would inform his opinion.
(3) Maybe this is worth flying around and getting second opinions on this from several bat docs?
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