Encouraging pBAT cycles 5,6 & 7 with darolutamide

[Ichthus316]

Below are blood test results since my last BAT update in Sept, 2024. Note the gradually lengthened hiT cycles. ADT (quarterly Eligard shot) is always in the background; darolutamide (Nubeqa) was introduced on the loT cycles in August.

On the 11th of March, I will have completed one full, continuous year on this non-SOC therapy. Side effects are minimal. Energy level and sexual function are good. I have hormone sensitive, metastatic, Gleason 9 PCa, diagnosed in 2019 (see bio for more info).

10-9-24, end of 5th hiT cycle (23 days, 12 Tp injections):

PSA = 0.66

E2 = 3 (should be between 10 and 30)

11-8-24, end of 5th loT cycle (28 days, 3 wks Nubeqa @ half dose, 1 wk washout):

PSA = 0.07

E2 = 21 (using .025 mg/d E2 patch on all loT cycles; loT targeted E2 much easier to hit)

11-22-24, after 2 wks of 6th hiT cycle (7 Tp injections):

PSA = 0.35

E2 = 61 (no letrozole was taken for first 2 wks of loT due to low E2 on previous cycle)

12-13-24, end of 6th hiT cycle (34 days total, 17 Tp injections):

PSA = 0.53

T = 2769 (measured 7 hrs after Tp injection, which varies between 50 and 60 mg)

E2 <2 (.0625 mg letrozole taken 3 days prior to test, confirming high sensitivity to AI)

12-27-24, after 2 wks of 6th loT cycle (with 2 wks of Nubeqa @ half dose):

PSA = 0.11

1-10-25, end of 6th loT cycle (28 days total, 3 wks Nubeqa @ half dose, 1 wk washout):

PSA = 0.05

E2 = 19

1-24-25, after 2 wks of 7th hiT cycle (8 Tp injections):

PSA = 0.33

E2 = 2 (having difficulty adjusting timing of letrozole dose)

2-7-25, after 4 wks of 7th hiT cycle (15 Tp injections):

PSA = 0.44

E2 = 47

2-21-25, end of 7th hiT cycle (42 days total, 22 Tp injections):

PSA = 0.58

E2 = 23 (.03 mg letrozole taken 2 wks prior to BT; 1/8th of a pill hard to accurately split)

Please let me know if you have any thoughts, questions, or suggestions.

[PCaWarrior]

Excellent! I'm glad you're using ADT continuously. Unfortunately, it's common to think that ADT drugs interfere with exogenous testosterone. They don't!

Tp = T propionate? Good good good. Clears fast.

Daro. Good good good. It's my preference also. Daro is an ARSI. When I say ADT drugs I mean drugs that lower your internal testosterone. ARSIs inhibit the ARs and will interfere with external T if you aren't careful. Daro clears fast, in 4-5 days.

You might consider adding 3-4 days of olaparib to the start of the high T phase. I start a couple of days prior and continue for a couple of days during high T. It works regardless of HRR status. Cell studies need to be taken with a grain of salt but they strongly indicate that the DSB damage occurs in the first hours or days of high T introduction.

Another thing you might consider down the road is the introduction of rapid BAT pulses. They can easily be done with gels or orals. I've done over a dozen of them and my PSA dropped every time (except once when it went up slightly). Good thing about them is that they can be easily folded into your low T phases. I am going to do 3 of them this cycle.

[Ichthus316 in reply to PCaWarrior]

Yes, Tp = T propionate. Both olaparib and rBAT are definitely on my radar for future BAT cycles , although I have not been tested for the BRCA mutation. Great to hear from you!

[PCaWarrior in reply to Ichthus316]

I'm not BRCA. A clinical trial, albeit small, indicates that BRCA or non-BRCA makes no difference. Olaparib synergizes with BAT.

I think that this could be a lightly smoking gun that at least in part BAT works by creating DSBs. Introduce a PARP inhibitor and boom, dead cancer cells.