PCRI’s Executive Director, Mark Scholz, MD, gives an overview of the standard treatments for Low and Basic Azure (High-Risk) prostate cancer. He explains why these treatments are optimal and discusses other alternative treatments.
0:34 Understanding “high-risk prostate cancer.” The term high risk is referring to the likelihood of relapse after standard treatment like surgery. It is not referring to a high risk of mortality. PCRI divides this category into three subtypes, Low, Basic, and High Azure.
1:06 Low-Azure also known as “favorable high-risk” consists of a Gleason 8 (not higher), PSA less than 40 ng/ml, less than 3 biopsy cores from a random biopsy containing Gleason 8 with no cores more than 50% replaced with cancer, no spread outside the gland.
1:37 Basic Azure is everything between Low and High Azure. High Azure consists of spread outside the gland, PSA greater than 40, and a Gleason 9/10
1:52 Treatment for Low-Azure is similar to High-Teal (unfavorable intermediate-risk) which includes beam radiation, radioactive seed implant, and a short course of hormone therapy. Some doctors recommend surgery for Low-Azure. If surgery is to be considered, it should only be considered for Low-Azure, not for Basic or High Azure, since there is a higher chance of disease outside the gland. There is preliminary research that shows that men with Low-Azure can consider a seed implant alone, forgoing hormone therapy and beam radiation. This has yet to be confirmed with a phase 3 trial, but it is a reasonable consideration.
3:50 Treatment for Basic-Azure is beam radiation to the prostate and the surrounding lymph nodes, radioactive seed implant, and 18-24 months of hormone therapy. There is a greater chance of microscopic spread to the lymph nodes, so the longer course hormone therapy can help fight cancer outside the gland. This combined with radiation to the surround lymph nodes increases cure rates.
5:13 Options for beam radiation include proton therapy, IMRT, SBRT. All options are essentially interchangeable in terms of cure rates.
5:54 Summary. The main difference between treatment for Low and Basic Azure is the duration of hormone therapy (4 months vs 18-24 months) and including the pelvic lymph nodes in the radiation treatment. Also, men with Low Azure can consider a seed implant monotherapy or surgery.
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