4th pBAT cycle results with Darolutamide questions

[Ichthus316]

Blood Test Results:

8-16-24, end of 4th hiT cycle, drawn 7 hours after 11th T injection:

PSA = 2.25 (similar to previous cycles)

E2 = 87 (should be <30, so have re-introduced the AI letrozole in ongoing 5th hiT cycle)

9-3-24, middle of loT cycle, drawn after 1 week @ full dose Nubeqa and 1 wk half dose:

PSA = 0.48

E2 = 21 (taking low dose E2 patch, .025 mg/d during all loT phases)

9-16-24, end of 4th loT cycle, drawn after 3 wks Nubeqa (2 wks @ half dose) + 6 day washout

T = 16 ng/dL (T reached a low while on Lupron ADT of <2.5 in May, 2023)

PSA = 0.14 (was 0.59 at end of 3rd loT cycle – good response to Nubeqa)

9-16-24 started 5th hiT cycle, planned for 26 days

10-12-24 projected start of 5th loT cycle

The results of the exBAT trial, which utilizes Daro (Nubeqa) during the loT phase of BAT, are still a year or two away, so I’m a bit nervous about using Daro every loT cycle.

What are the risks of taking Daro as above during every loT phase?

Should I be concerned about the development of resistance to this ARSI?

If so, can indomethacin (or something else) forestall resistance?

Can ARSIs eventually feed PCa growth?

[MateoBeach]

sorting out your pBAT Regimen looks like you are doing about one month of high-T alternating with one month of low T. Is that correct? And you add two weeks of darolutamide at front of low-T cycle to block ant residual testosterone that might be carried over. One week full dose and one week half dose. That is a very good plan IMO though I would be inclined the duration of high T to perhaps two months. Something to consider.

I presume you are also on some form of ADT as well. Without it the darolutamide may effectively block AR receptors but it can leave higher testosterone levels if the testicular axis is capable of responding. Unknown what effect this has with BAT. Personally I take Orgovyx during my low T month and also use darolutamide at half dose during the first two weeks.

I share your concern about developing resistance to darolutamide so that is why I also keep exposure brief. Like other ARSIs it can undergo antagonist to agonist mutations even though it is much less susceptible than for other ARSIs. MB

[Ichthus316 in reply to MateoBeach]

Thanks for the reply! I’ve been following your posts for a year or so and I value your experience and insights. I hope your recovery is going well.

You are correct about the length of my cycles. I’m currently adding 3 full weeks of daro during loT, the last 2 of those at half dose. Since starting BAT last spring, I’ve been extending hiT by 1 or 2 shots each cycle. I plan to continue doing so as long as my PSA at the end of hiT remains stable. I take Eligard shots every 12 weeks, so ADT is always running in the background. I wouldn’t mind switching to Orgovyx, though.

I’m leaning toward only adding Daro to my BAT regimen every other cycle, at least for now… due to possible resistance, mutations, and other unknown risks. However, since long periods without T presents its own risks, I may start adding Daro to additional loT cycles if the time to reach baseline PSA without it keeps growing. Sound reasonable?