BAT + EGCG + Sulforaphane + Curcumin + Ellagic Acid + Lycopene

[PCaWarrior]

I've been taking the combo for 6 years and added BAT 4 years ago.

1. Nutraceutical Combination: EGCG, Sulforaphane, Curcumin, Pomegranate Juice, and Lycopene

Individual Contributions:

• EGCG (from green tea/matcha): Doses of 400–800 mg/day have been shown to modestly reduce PSA levels and slow tumor proliferation.

• Sulforaphane (from broccoli sprout extract): A typical dose of ~60 mg/day can significantly extend PSA doubling time.

• Curcumin: Administered at 1.4–3 g/day (preferably with a bioavailability enhancer like piperine) reduces AR expression and improves PSA kinetics.

• Pomegranate Juice/Extract: About 8 oz of juice or 1 g of standardized extract daily has been associated with prolonged biochemical recurrence‐free intervals.

• Lycopene: Doses around 7–30 mg/day (from tomato-based products) are linked with a lower risk of prostate cancer progression, likely via antioxidant activity and modulation of AR signaling.

Combined Effects:

Studies using a multi-ingredient blend (e.g. the Pomi-T formulation) have demonstrated that combining several polyphenols can reduce the PSA growth rate by over 60% compared to placebo. Adding lycopene to this regimen is expected to further support an anti-androgen and antioxidant environment, potentially enhancing the overall efficacy. In preclinical models, these agents target complementary pathways (AR signaling, cell cycle regulation, apoptosis, and inflammatory cytokines), suggesting that the combination is more potent than any single element.

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2. Treatment Contexts and Predicted Impact

A. Without BAT (Using Standard ADT Alone)

• Nutraceuticals Alone: When added to standard ADT, these supplements have been shown to modestly slow PSA progression and extend PSA doubling time. Individually, EGCG, sulforaphane, curcumin, and pomegranate have each yielded improvements in biochemical kinetics. Adding lycopene, which is supported by epidemiologic data, might further lower PSA levels and provide a chemopreventive effect. Overall, one might estimate a 10–20% improvement in biochemical recurrence control (BCR) and a modest extension of radiographic progression-free survival (rPFS) by a few months.

• Outcomes: Expected PSA50 responses may remain low (perhaps <20%); tumor shrinkage is unlikely as a stand-alone effect, but slowing of progression (PSADT increase) is the primary benefit.

B. With ADT/ARSI (e.g., Darolutamide or Orgovyx)

• Combination with Modern AR Blockade: When these nutraceuticals are added to standard ADT plus a next-generation AR signaling inhibitor (ARSIs such as darolutamide) or abiraterone (Zytiga), their complementary actions may enhance AR pathway suppression. ARSIs typically yield PSA50 responses in 25–30% of patients. With the addition of the nutraceutical blend, the probability might increase to an estimated 40–50% PSA50 response rate, given improved control of oxidative stress, AR downregulation, and anti-inflammatory effects.

• Outcomes: rPFS may be modestly extended (e.g., an increase from 6 to 7–8 months in progression-free intervals) and delays in biochemical recurrence are anticipated. While definitive improvements in cancer-specific survival (CSS) and overall survival (OS) have not been established, the enhanced biochemical control could eventually translate into improved long-term outcomes in selected patients.

C. With BAT

• Synergistic Potential with BAT: BAT alone has been reported to restore sensitivity to AR-targeted therapies in approximately 60–78% of patients (as measured by PSA responses on subsequent re-challenge). Adding the nutraceutical regimen to BAT may further enhance the resensitization effect by reducing AR signaling fluctuations and mitigating inflammatory stress. The combination is expected to raise PSA50 response rates and improve the durability of responses.

• Outcomes: One might predict that, with the nutraceuticals, the overall resensitization rate could potentially increase from a baseline of ~60% (with BAT alone) to approximately 70–80% in ideal conditions. In this context, the rPFS on subsequent AR-targeted therapy might be extended by an additional 2–3 months over BAT alone, though data remain preliminary. This combination could also improve biochemical control (BCR delay) compared to BAT or ARSI/ADT alone.

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3. Synergistic Rationale and Robustness of Opinion

The combination of these five agents is hypothesized to be synergistic because:

• They each target distinct, complementary pathways (e.g., AR signaling modulation, antioxidant activity, inhibition of inflammatory cytokines, and promotion of apoptosis).

• Clinical trials of combination polyphenol formulations (e.g., Pomi-T) have demonstrated significant PSA stabilization compared to placebo.

• Preclinical studies consistently show that when used together, these agents yield a more pronounced effect on slowing tumor cell proliferation and PSA progression than any single component.

• The synergy appears to be robust for intermediate endpoints (PSA kinetics and PSADT), though its translation to long-term outcomes (CSS, OS) requires further study. Based on current evidence, I estimate that the combination is approximately 30–50% more effective in delaying progression than any individual supplement.

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4. Summary

• Without BAT: Nutraceuticals may modestly improve biochemical control when added to standard ADT (10–20% benefit in BCR and a few extra months of rPFS).

• With ADT/ARSI (darolutamide or Zytiga): The combination is predicted to improve PSA50 response rates to ~40–50% and modestly extend progression-free intervals.

• With BAT: When combined with BAT, the overall resensitization rate might increase from approximately 60% (BAT alone) to around 70–80%, with additional extension of rPFS by 2–3 months.

While the precise impact on CSS and OS remains uncertain, the combination appears to be more effective than any individual component, supported by both clinical and preclinical data. The estimated dosages (EGCG 400–800 mg/day, curcumin 1.4–3 g/day, sulforaphane 60 mg/day, pomegranate juice 8 oz/day or 1 g/day extract, and lycopene 7–30 mg/day) are well within safe limits and have been used in multiple studies.

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References (Footnote List)

1. Jin et al. (2024). Cellular senescence in metastatic prostate cancer: A therapeutic opportunity or challenge. Molecular Medicine Reports, 24(2):162. URL: spandidos-publications.com/...

2. Kim HJ et al. (2019). Curcumin in intermittent ADT for prostate cancer: A randomized placebo-controlled trial. The Prostate, 79(6):614–621. URL: nature.com/articles/s41391-...

3. Thomas R et al. (2014). Pomi-T Polyphenol Supplement vs. Placebo in men on active surveillance: A 6-month RCT. Prostate Cancer and Prostatic Diseases, 17(2):180–186. URL: nature.com/articles/pcan201416

4. Cipolla BG et al. (2015). Sulforaphane in biochemical recurrence: Results of a randomized double-blind trial. Cancer Prevention Research, 8(8):712–719. URL: ncbi.nlm.nih.gov/pmc/articl...

5. Paller CJ et al. (2013). Phase II Study of Pomegranate Extract in Men with Rising PSA after initial therapy. Prostate Cancer and Prostatic Diseases, 16(1):50–55. URL: pubmed.ncbi.nlm.nih.gov/233...

6. McLarty J et al. (2009). Green tea extract in early prostate cancer: A pre-prostatectomy study. Cancer Prevention Research, 2(7):697–705. URL: pubmed.ncbi.nlm.nih.gov/195...

7. Choi HY et al. (2010). Curcumin interrupts AR and Wnt/β-catenin crosstalk in prostate cancer cells. Prostate Cancer and Prostatic Diseases, 13(4):343–349. URL: pubmed.ncbi.nlm.nih.gov/203...

8. UroToday. (2022). How Bipolar Androgen Therapy Works. URL: urotoday.com/learning/train...

9. Additional details on Pomi-T dosing and outcomes can be found in published summaries on nutraceutical interventions in prostate cancer. URL: clinicaltrials.gov

10. Further mechanistic and clinical data on these compounds are available in review articles in Cancer Prevention Research and The Prostate. URL: ncbi.nlm.nih.gov/pmc/articles/

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This analysis indicates that combining EGCG, curcumin, sulforaphane, pomegranate juice, and lycopene with BAT or standard ADT/ARSI regimens has the potential to significantly improve intermediate endpoints such as PSA50 responses and rPFS in HSPC, with additive or synergistic effects over individual agents. The exact long-term survival benefits remain to be established in larger, definitive trials.

[Rolphs]

I have taken Pom-T and /or the individual supplements contained in Pom-T since my diagnosis 4 years ago. I think it complements SOC (for me Xtandi, Orgovix and Doci) in keeping me castrate sensitive. My PSA started at 930 and gradually worked its way down to a nadir of .2 for more than a year. I thought this was a nadir but the last 4 months my PSA has been .1! My ONC said don’t worry about the fluctuations at that level but nevertheless I am happy and of course grateful.

[PCaWarrior in reply to Rolphs]

I used to take Pom-T but then I read the label.... Most of it is just powdered stuff and really not much. I saw their trial though. Results looked promising. It's kind of a marketing job IMO. I could be very wrong but look into it.

A quarter of all supplements are contaminated, usually with heavy metals. Finland? is the worst. So I ended up trying to get whatever I can from organic food. Sometimes the concentration just isn't high enough so I break down and get a supplement.

[Ichthus316 in reply to PCaWarrior]

I drink lots green tea, but supplement w/ LE EGCG, trying to hit around 800 mg/d. I get pomegranate mainly from 10 g/d or so of powdered pomegranate using whole arils. I get lycopene primarily from jars of tomato paste, mixing around 65 g into my daily veggie juice. Because of the bioavailability issue, I add piperine to a 1 g/d nano version of curcumin. I recently decided to drop sulforaphane due to high cost, but I do eat a ton of cruciferous veggies, including broccoli sprouts on occasion.

In addition to extending PSADT, my hope has been to reduce the risk of distant metastases. Pleased to see these potential benefits of other metrics and synergies with BAT and daro.

I take other supplements as well, but try to avoid all antioxidants (which can be a challenge) on the first few of days of each new BAT cycle, both low & high T. This is to avoid interfering w/ potential apoptosis of PCa cells due to rapid cycling of androgens.

Do you do something similar?

[PCaWarrior in reply to Ichthus316]

Similar, I drink 8 glasses of green tea. It's a pain but I keep seeing reports of lead in EGCG supplements and I know how things can be fudged at medical companies (used to work for one). Even if I see testing... I get lycopene from tomato paste. Couple of ounces a day. Curcumin and sulforaphane I get primarily from sups. Pomi juice - 8 oz a day. Coffee - grind my own beans and drink a lot of it - fortunately I love coffee.

[Ichthus316 in reply to PCaWarrior]

Thanks. Do you shut down antioxidants during the first couple of days of each phase of BAT cycle?

[PCaWarrior in reply to Ichthus316]

No. I don't take a lot of antioxidants at any time. I understand the logic though. High T generates lots of ROS. So do some types of chemo. I could see this going either way.

From ChatGPT:

n a high‑testosterone environment—such as during bipolar androgen therapy (BAT) for prostate cancer—there is an increased production of reactive oxygen species (ROS) and oxidative stress as a byproduct of intense androgen receptor activation. Some of the anti‑cancer effects of BAT may be partly due to the oxidative damage (including DNA double‑strand breaks) that high testosterone levels induce in tumor cells. In this setting, antioxidants could theoretically reduce oxidative stress and protect cells from damage.

On one hand, this might be beneficial systemically (for example, protecting normal tissues from oxidative injury, improving cardiovascular health, or reducing inflammation). On the other hand, if antioxidants are present during BAT, they might blunt the intended pro‑oxidant, tumor‑damaging effects of the high testosterone pulses. In other words, by scavenging the free radicals produced during BAT, antioxidants could inadvertently shield cancer cells from the oxidative stress that helps drive their death, potentially reducing the overall efficacy of BAT.

The net effect of administering antioxidants during BAT in prostate cancer remains uncertain. Some preclinical studies suggest that excessive antioxidant supplementation can interfere with therapies that rely on ROS-induced cytotoxicity. However, clinical data are sparse, and it is not yet clear whether moderate antioxidant intake (for example, from a balanced diet) would have a significant impact—either positive or negative—on BAT’s effectiveness in PCa patients.

In summary, while antioxidants are generally health-promoting, in the context of BAT they could reduce the desired DNA damage in cancer cells, potentially diminishing the therapy’s impact. More research is needed to clarify whether antioxidants should be limited during BAT or if a balanced approach can protect normal tissues without compromising anti-tumor efficacy.

[Ichthus316]

Yeah, lead & other contaminants are a bit worrisome. That's why I only use a couple of reputable brands for supplements like LE. The following is hopefully true:

"Life Extension supplements are third-party tested and distributed by an NSF-certified facility."

"Life Extension products have been consistently recognized by ConsumerLab for their outstanding purity and quality."

[Ichthus316 in reply to Ichthus316]

Aren't all 5 of the nutraceuticals mentioned in your post antioxidants?

[PCaWarrior in reply to Ichthus316]

They are. And if you want to stop them, most of them wash out in under a day.

I simply haven't seen evidence to convince me that they are good (e.g. protective for healthy tissue) or bad (protective for cancerous cells via ROS neutralization) during the high T phase of BAT. So, double down? Reduce? Dice throw for me at this point.

I'm not convinced of "anti-oxidant" activity in general. I'm sure there are cell studies and research out there. I just haven't spent much time in this area. I don't have an actionable outcome to look at (e.g. a good phase 3 clinical trial).

[Ichthus316 in reply to PCaWarrior]

Thanks for your insights, much food for thought. Like you (although not nearly as complex and well-researched), I try to vary/improve my protocol to deter the beast from adapting and resisting. Stopping all supplements at the beginning of each cycle also gives my liver a break!

[PCaWarrior in reply to Ichthus316]

Very likely they are fine. LE is one of the better companies IMO. I get their curcumin - I don't recall who told me about it - Patrick or Nal.

Another question I have is "are we really smart enough to have figured out every single substance in a given food and what it does alone and in tandom with other substances in that food? And do we know that no synergists are possible? Or are they only the ones we've identified?"

But sometimes I feel I don't have much choice so I go to supplements if I have to. Good bet with synthetics that have been tested in clinal trials and studies (D3 for example). Not so great in other areas.