I think it's important to note that while there have been some interesting smaller studies, BAT isn't proven in bigger trials yet (those are underway now, one paired with Enzalutamide, and one paired with Xofigo).

Here's what Johns Hopkins says:

«"They called this alternating approach “Bipolar Androgen Therapy” (BAT) because it cycles between polar extremes of very high and very low male hormones. “The idea,” Denmeade explains, “is to mess up the cancer cell’s ability to adapt.” Paradoxically, although low levels of testosterone can make prostate cancer cells grow, “at high doses, the cancer cells don’t grow as well, or they die.”»

It seems they're testing it specifically on cancer that has already become castrate-resistant, *not* for castrate-sensitive prostate cancer — in other words, it is a potential next step once ADT stops working, not an alternative to ADT for nmCSPC or mCSPC.
https://www.hopkinsmedicine.org/news/articles/2023/12/bipolar-androgen-therapy-trials-under-way