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.