Hi, I’m Dr. Scholz, let’s talk about prostate cancer.
In today’s video we are going to cover the Azure stage of prostate cancer.
We always talk about stages of prostate cancer because the whole topic of prostate cancer
is so vast that you gotta break it down into categories. The Azure category is actually
a relatively small segment of prostate cancer which varies from harmless to people that
have cancer that has spread or metastasized. Azure means someone that is newly diagnosed,
but it appears that the disease is localized at least into the area of the pelvic region.
However, Azure men have certain factors that suggest a higher-risk type of prostate cancer.
As you no doubt know, some types of prostate cancer are harmless; others are minimally
dangerous. Azure needs real treatment and the best chance to cure it is on your first
effort. Now that doesn’t mean that with prostate cancer you don’t have second chances
and third chances, which is one of the unique aspects of prostate cancer. Many other types
of cancer you have one chance to cure it. Even so, it’s best to try and cure prostate
cancer with the first effort. Your quality of life is better. Who wants to go through
another treatment down the line and who wants to experience anxiety that’s associated
with the possibility of a cancer being out of control?
When we’re talking about Azure we divide it into Low, Basic, and High. Low-Azure is
basically small amounts of grade 8 that can be treated in many ways very similar to High-Teal.
And I’ll let you look up the video on that for further information about how to treat
Low-Azure. Basic and High-Azure are more consequential types of prostate cancer. The real issue is
the possibility of spread outside the prostate and Basic-Azure or High-Azure have at least
some risk of spread outside the prostate--possibly into the lymph nodes and the surrounding area.
It is possible to calculate the risk of microscopic spread outside the prostate with something
called the Yale Formula. Y-A-L-E Formula. You can Google that and put your numbers (your
PSA, your clinical stage) into that formula, and it will tell you the percentage likelihood
that there’s cancer spread outside the gland. This is an incredibly consequential fact because
you can do things about the possibility of spread. You can give radiation to the lymph
nodes, you can take hormone therapy, you can take augmented hormone therapy (things like
Zytiga or Xtandi), you can even take chemotherapy (although that’s usually reserved for men
who have scans that show unequivocal spread into the lymph nodes, not just people who
have a possibility of microscopic spread).
Basic-Azure, High-Azure -- how do you make that distinction? Anyone that has a Gleason
9 or 10 grade, a PSA above 40, or has a scan showing spread into the seminal vesicles or
into the pelvic lymph nodes has High-Azure. Other men in the Azure category (and you know
how to find out of you’re in the Azure category, you have to take the PCRI staging quiz) other
men in the Azure category if they’re not High-Azure are Basic. So how do you treat
those differently? Well, Basic-Azure typically is managed with a seed implant, intensity
modulated radiation (IMRT), and 18 months of hormone therapy. Whether or not the radiation--the
IMRT radiation--is directed to the lymph nodes is based on the results of the Yale Formula
we talked about previously. If the chance of spread according to the Yale Formula is
over 15% you should probably treat the pelvic lymph nodes. How do we treat High-Azure? We
give all the same treatments that we give to Basic-Azure except we consider adding Zytiga
or Xtandi for the 18 month period, or if a person has unequivocal lymph node enlargement
on a scan, then even the possibility of four to six cycles of a type of chemotherapy called
Taxotere.
So in summary, Azure is a more consequential type of prostate cancer. We always like to
emphasize that most men with Azure are curable, and of course curable means getting optimal
therapy. There are many centers that are still recommending surgery for Azure, and I don’t
think that’s a good idea. The cure rates are much lower and the side effects tend to
be even higher with surgery compared to the other options that we have already covered.