With most cancers “relapse” is a fatal pronouncement.  Thankfully, most relapses are controllable for a decade or more with hormone therapy.  However, when the relapse can be cured, the advantage is indisputable.  Here is a list of potential treatment options for Indigo:

1. Observation alone

2. Mild hormone therapy with Casodex plus Avodart

3. Combination hormone therapy with intermittent Lupron and Casodex

4. Fossa radiation, seed implant or cryotherapy for persistent local disease

5. Same as #4 but with the addition of pelvic radiation and 4 months of hormone therapy

6. Same as #5 but with hormone therapy extended for 18 months

7. Same as #6 but with the addition of Taxotere or Zytiga or Xtandi

Different Subtypes of Indigo Require Different Treatment

Treatment intensity should be dialed up or down in accordance with the subtype of Indigo.  For example, men who have regional pelvic lymph node metastases (High-Indigo) require more intense treatment than men with a local relapse, having cancer only in the prostate gland or prostate fossa (Low-Indigo).  Men without proven metastases, but who have factors suggesting a high likelihood of microscopic pelvic lymph node disease, are considered Basic-Indigo.

Estimating the Risk of Microscopic Disease

When scans show no evidence of metastases, doctors estimate the likelihood of microscopic cancer in the pelvic lymph nodes (generally the first area of the body where prostate cancer metastasizes) by measuring the PSA-doubling time and revisiting the original stage (Sky, Teal vs. Azure). Men with faster doubling times or higher stage are more likely to have microscopic metastases.

A whole section of The Key to Prostate Cancer is devoted to making Indigo 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.

Indigo is categorized by a relapse after surgery or radiation. The good news is that most prostate cancer relapses are controllable for a decade or longer and some are even curable. Indigo subtypes (Low, Basic and High) are assigned by knowing the original stage (before treatment), PSA, the PSA-doubling time and by imaging with scans. The higher the original stage and the quicker the PSA-doubling points to a greater chance of metastasis in the lymph nodes. Check out the Indigo section of The Key to Prostate Cancer for answers to the following questions. It is a good idea to discuss these questions with your doctor to apply them to your specific case.

1.  In what cases can the Indigo stage be monitored instead of treated?

2.  If a relapsed prostate cancer doesn’t get cured, will I die?

3.  Does treatment depend on what type of treatment I had previous to relapse?

4.  What should I be most concerned about?

5.  Why does hormone therapy work for treating prostate cancer?

6.  What side-effects frequently occur with Testosterone inactivating pharmaceuticals (TIP)?

7.  Are side-effects of TIP reversible?

8.  If I am reacting poorly to TIP, will I be able to adjust frequency or dosage without affecting my cure rates?

9.  How often will I be monitored for treatment success?

10.  When I am taking TIP will I have the option of taking a “treatment holiday?”