Understanding Treatment for High-Risk Prostate Cancer | Prostate Cancer Staging Guide
Hi, I’m Dr. Scholz, let’s talk about prostatecancer. In today’s video we are going to cover theAzure stage of prostate cancer. We always talk about stages of prostate cancerbecause the whole topic of prostate canceris so vast that you gotta break it down intocategories. The Azure category is actuallya relatively small segment of prostate cancerwhich varies from harmless to people thathave cancer that has spread or metastasized. Azure means someone that is newly diagnosed,but it appears that the disease is localizedat least into the area of the pelvic region. However, Azure men have certain factors thatsuggest a higher-risk type of prostate cancer. As you no doubt know, some types of prostatecancer are harmless; others are minimallydangerous. Azure needs real treatment andthe best chance to cure it is on your firsteffort. Now that doesn’t mean that withprostate cancer you don’t have second chancesand third chances, which is one of the uniqueaspects of prostate cancer. Many other typesof cancer you have one chance to cure it. Even so, it’s best to try and cure prostatecancer with the first effort. Your qualityof life is better. Who wants to go throughanother treatment down the line and who wantsto experience anxiety that’s associatedwith the possibility of a cancer being outof control?When we’re talking about Azure we divideit into Low, Basic, and High. Low-Azure isbasically small amounts of grade 8 that canbe treated in many ways very similar to High-Teal. And I’ll let you look up the video on thatfor further information about how to treatLow-Azure. Basic and High-Azure are more consequentialtypes of prostate cancer. The real issue isthe possibility of spread outside the prostateand Basic-Azure or High-Azure have at leastsome risk of spread outside the prostate–possiblyinto the lymph nodes and the surrounding area. It is possible to calculate the risk of microscopicspread outside the prostate with somethingcalled the Yale Formula. Y-A-L-E Formula. You can Google that and put your numbers into that formula,and it will tell you the percentage likelihoodthat there’s cancer spread outside the gland. This is an incredibly consequential fact becauseyou can do things about the possibility ofspread. You can give radiation to the lymphnodes, you can take hormone therapy, you cantake augmented hormone therapy , you can even take chemotherapy(although that’s usually reserved for menwho have scans that show unequivocal spreadinto the lymph nodes, not just people whohave a possibility of microscopic spread). Basic-Azure, High-Azure — how do you makethat distinction? Anyone that has a Gleason9 or 10 grade, a PSA above 40, or has a scanshowing spread into the seminal vesicles orinto the pelvic lymph nodes has High-Azure. Other men in the Azure category (and you knowhow to find out of you’re in the Azure category,you have to take the PCRI staging quiz) othermen in the Azure category if they’re notHigh-Azure are Basic. So how do you treatthose differently? Well, Basic-Azure typicallyis managed with a seed implant, intensitymodulated radiation , and 18 monthsof hormone therapy. Whether or not the radiation–theIMRT radiation–is directed to the lymph nodesis based on the results of the Yale Formulawe talked about previously. If the chanceof spread according to the Yale Formula isover 15% you should probably treat the pelviclymph nodes. How do we treat High-Azure? Wegive all the same treatments that we giveto Basic-Azure except we consider adding Zytigaor Xtandi for the 18 month period, or if aperson has unequivocal lymph node enlargementon a scan, then even the possibility of fourto six cycles of a type of chemotherapy calledTaxotere. So in summary, Azure is a more consequentialtype of prostate cancer. We always like toemphasize that most men with Azure are curable,and of course curable means getting optimaltherapy. There are many centers that are stillrecommending surgery for Azure, and I don’tthink that’s a good idea. The cure ratesare much lower and the side effects tend tobe even higher with surgery compared to theother options that we have already covered.