Understanding Treatment for High-Risk Prostate Cancer | Prostate Cancer Staging Guide

PCRI’s Executive Director, Mark Scholz, breaks down Azure (high-risk) into subtypes and discusses the subtle differences between their treatment protocols.

0:28 The Azure category is a relatively small subset of prostate cancer as a whole. What doctor’s call “high-risk” disease can span from small localized disease to disease that has metastasized into the pelvic region. It’s important to know which type of high-risk disease you are dealing with to choose the best treatment plan. Ideally, you want to cure the disease with the first treatment since one has the highest likelihood of cure. Luckily though, prostate cancer does afford second and third chances for cure, unlike other cancers.

1:36 Since Azure (high-risk) spans a wide range of disease states we break it down into three categories: Low, Basic and High. Low Azure is small amounts of Gleason 8 confined to the prostate. Treatment is similar to High Teal (unfavorable intermediate-risk). What differentiates Basic and High Azure from Low Azure is the chance of spread outside the prostate. With Basic Azure, there is a lower, and with High Azure there is a strong possibility or a confirmed presence of spread outside the gland.

2:15 It is possible to calculate the risk of spread outside the prostate with the Yale Formula, a formula that generates a percentage based on numbers like PSA, Gleason score, clinical stage, etc. Treatment can be adapted based on the results of this formula. Radiation can be given to the surrounding lymph nodes; more or stronger hormone therapy can be given. Chemotherapy is also an option although this is reserved mainly for men with scans showing unequivocal spread into the seminal vesicles or lymph nodes.

3:05 Differences between Basic and High Azure. High Azure has PSA over 40, Gleason score of 9 or 10, or scans showing spread into the surrounding lymph nodes. Men without any of these risk factors, are Basic Azure.

3:39 What is the difference in treatment? Men with Basic Azure receive beam radiation, a radioactive seed implant and 18 months of hormone therapy. Whether or not the beam radiation is directed toward the surrounding lymph nodes depends on the results from the Yale Formula. If the result from the Yale formula is above 15%, the lymph nodes should be treated. Men with High Azure can consider adding a second generation hormone therapy such as Zytiga or Xtandi to the protocol as mentioned earlier, or if scans show spread to the surrounding area, 4-6 cycles of Taxotere chemotherapy can be considered.

4:55 It is important to choose the best treatment for Azure first. Surgery shows much lower cure rates for this type of prostate cancer and should be avoided.

Don’t know your stage? Take the quiz: Visit http://www.prostatecancerstaging.org

To learn more about prostate cancer visit http://www.pcri.org

To download the free Staging Guide visit http://www.pcri.org/prostate-cancer-staging

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