Bipolar androgen therapy (BAT): A patient's guide

Samuel Denmeade, Emmanuel S. Antonarakis, Mark C. Markowski

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Bipolar androgen therapy (BAT) is a new treatment concept for men whose prostate cancer has become resistant to standard hormone-blocking therapy. Over the past decade, we have performed a series of clinical studies testing BAT in asymptomatic men with castration-resistant prostate cancer. The key findings from these clinical studies are that BAT (a) can be safely administered to asymptomatic patients with metastatic castrate-resistant prostate cancer; (b) does not produce symptomatic disease progression; (c) produces sustained prostate-specific antigen and objective responses in 30%–40% of patients; and (d) can resensitize and prolong response to subsequent antiandrogen therapy. The concept of BAT has generated significant interest from men with prostate cancer, their families, and their physicians. Here we provide a “Patient's Guide” that answers questions about BAT in a form that is accessible to patients, their families, and physicians. Our goal is to provide information to help patients make the most informed decisions they can regarding their prostate cancer treatment.

Original languageEnglish (US)
Pages (from-to)753-762
Number of pages10
Issue number7
StatePublished - May 15 2022

Bibliographical note

Funding Information:
We acknowledge all of the brave patients who agreed to take the leap of faith with us and participate in our BAT clinical trials. We also wish to acknowledge the dedicated work of our entire prostate cancer research team of oncologists, scientists, research nurses, study coordinators and administrators at Johns Hopkins who worked so diligently to complete the BAT clinical studies.

Funding Information:
Thus far we have only evaluated the effects of one cycle of BAT → Xtandi. Currently, we are conducting the “Sequential Testosterone and Enzalutamide Prevents Unfavorable Progression (STEP‐UP) trial (NCT04363164) at Johns Hopkins and several other sites around the United States. This three‐arm study will determine the safety and effectiveness of repeat cycles of BAT → Xtandi in men with CRPC progressing on Zytiga (Figure 6 ). The study is sponsored by a grant from the DoD Prostate Cancer Research Program and funding from Astellas, the manufacturer of Xtandi.

Publisher Copyright:
© 2022 The Authors. The Prostate published by Wiley Periodicals LLC.


  • androgen deprivation
  • antiandrogen
  • bipolar androgen therapy
  • castration resistant
  • Testosterone
  • Androgens
  • Androgen Antagonists/therapeutic use
  • Humans
  • Male
  • Prostatic Neoplasms/drug therapy
  • Prostatic Neoplasms, Castration-Resistant/drug therapy
  • Disease Progression

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, Non-U.S. Gov't


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