Azure is called “High-Risk” in standard doctor terminology.  However, patients tend to misinterpret “high-risk” as related to dying.  This is not true.  The risk of death is low.  However, cancer relapse after surgery or radiation occurs more frequently compared to Sky or Teal. So, to maximize cure rates, Basic-Azure is treated with a combination of radioactive seed implantation, IMRT and hormone blockade continued for 18 months (Basic-Azure is differentiated from other types of Azure as being neither Low- or High-Azure).

Three Subtypes of Azure

The three subcategories are Low, Basic, and High. To qualify as Low-Azure, only small amounts of Gleason 8 tumor can be present, and that only in one or two biopsy cores. All the other factors must be like Sky. With Low-Azure, the duration of hormone therapy can be reduced to four months rather than 18.  High-Azure is present whenever there is any Gleason 9 or 10, the PSA is over 40, a large tumor is noted on DRE, more than 50% biopsy cores are positive or cancer has invaded into the seminal vesicles, the bladder, the rectum, or the pelvic lymph nodes.  Treatment for High-Azure is the same as Basic-Azure except that consideration is given to adding Taxotere, Zytiga or Xtandi.

A whole section of The Key to Prostate Cancer is devoted to making Azure understandable to patients.  This book, in addition, provides information about diet, exercise, general men’s health, supplements, biopsies, scans, as well as a chapter about how to recognize and select the best doctors.

Azure is also referred to as “high-risk.”  This does not necessarily mean you are at higher risk of dying of prostate cancer. However, there is a higher risk of metastasis and a higher rate of relapse after treatment. Azure is typically treated with a combination of two or more types of therapy. 

Below are some relevant questions addressed in the Azure section of The Key to Prostate Cancer that men should discuss with their doctors.  

1.  What does a treatment schedule of combination therapy look like?

2.  How do I decide between High-Dose-Rate (HDR) and Low-Dose-Rate (LDR) seed implants?

3.  Could receiving radiation therapy increase my chance of developing a new type of cancer?

4.  How do I know if the treatment is working?

5.  Is impotence or incontinence from radiation treatment reversible?

6.  What is the difference between proton and photon radiation therapy

7.  How will blocking my testosterone affect my lifestyle?

8.  How do I counteract side effects from Lupron such as fatigue, loss of libido, and weight gain?

9.  Will testosterone replacement therapy post-treatment be an option for me?

10.  How does adding Taxotere interact with radiation and TIP?