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.

[Ichthus316 in reply to PCaWarrior]

I met with my MO today, and we discussed Lynparza (olaparib). I gave him a copy of the trial results you mentioned last week showing a 47% PSA50 response regardless of HRR gene mutation status. This was news to him, but he still suggested obtaining a specimen from my 2022 salvage surgery & testing for mutations because Medicare is more likely to approve the drug if I have a BRCA mutation.

I read somewhere that olaparib doesn’t have FDA approval for HSPCa. Do you know if that’s true? If so, Medicare could decline coverage even if I have the mutation. How did you get yours?

I’m also borderline anemic. For years, my CBC has shown a low red blood cell count just on either side of the low normal cutoff. My PCP thinks it’s probably an iron storage problem, because iron levels are good but ferritin is low normal. A few weeks ago, I started taking lactoferrin (that I already had) 1x/wk hoping to improve this. I understand that olaparib can cause bone barrow problems, including low blood cell counts. But is that a concern if it’s only taken 4 days at the beginning of each cycle, as you are doing?

[PCaWarrior in reply to Ichthus316]

I'm really sorry but I can't divulge how I get my Olaparib. Confidentiality...

I can address the low blood count question though. Androgens stimulate red blood cell production. Taking Olaparib for 4 days doesn't attenuate it enough. My RBC parameters were low (anemia) going into BAT. Now they are so high that I might have to give blood if they don't drop enough on this ADT phase.

Having RBC, hemoglobin and hematocrit above normal is a good problem to have.