ROYAL

Men with metastatic prostate cancer live substantially longer compared to men with metastases from other types of cancer. Royal subdivides into three categories: Low-Royal is present in men with hormone resistance (defined as a rising PSA while testosterone is low) but scans showing no metastases. Men with Basic-Royal have five or fewer metastases. Men with High-Royal have more than five metastases. The treatment will vary according to subtype. Frequent monitoring with PSA and scans is essential to confirm its effectiveness.  Treatment should be quickly changed if the initially selected therapy becomes ineffective.

Men in Royal category who have never had hormone therapy should start with Lupron plus Zytiga or Taxotere. In addition, patients who have five or fewer metastasis should consider radiation therapy aimed at the metastases. If the cancer becomes resistant to Lupron, the next step is to start Provenge, which boosts the immune system. Other options to consider are Xofigo, a form of injectable radiation, Jevtana, another type of chemotherapy or a clinical trial using a new investigational agent

Physical strength and bone health play in important role in achieving good outcomes and maintaining a good quality of life.  Resistance training with weights under the supervision of a trainer to build strength is essential. For bone strength, unless there are medical contraindications, everyone in Royal should receive Xgeva or Zometa.

A whole section of The Key to Prostate Cancer is devoted to making treatment selection for Royal understandable.  Key also 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.

A whole section of The Key to Prostate Cancer is devoted to making treatment selection for Royal understandable to patients.  Key also 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.

Men who have metastatic prostate cancer that has spread outside the pelvic region or has become Lupron-resistant are in the Royal stage of prostate cancer. Men with Royal still live substantially longer compared to men with metastases from other types of cancer. Hormone resistance is defined as a rising PSA while the testosterone level in the blood is low. At the first sign of Lupron resistance, treatment should be immediately changed. The following are questions men with the Royal stage of prostate cancer should consider. Answers may also be found in the Royal section of The Key to Prostate Cancer.

1.  How does Lupron resistance occur?

2.  If I become Lupron resistant, what are my other options?

3.  I was administered testosterone inactivating pharmaceuticals (TIP) at an earlier stage, but after treatment my prostate cancer returned. Does this mean I am resistant to TIP?

4.  How quickly does it take for someone to become resistant to TIP?

5.  How often should treatment success be monitored through PSA testing or scanning?

6.  Is there any way to prevent TIP resistance?

7.  How does having metastasis outside of the pelvic lymph nodes affect other organs and systems?

8.  Are there any current clinical trials for men with hormone resistant prostate cancer?

9.  How does lack of testosterone affect my overall health?

10.  I’ve heard prostate cancer is slow growing. Why then does resistance to Lupron require a more immediate solution?