PCRI’s Executive Director, Mark Scholz, MD, distinguishes the HighIndigo stage of prostate cancer as relapsed disease with proven metastasis in the pelvic lymph nodes (but not further) and describes the optimal combination of radiation, hormone blockade and chemotherapy to have the best chance at achieving a long remission and even possibly a cure.

:31 The Indigo stage of prostate cancer describes situations in which cancer has returned after initial surgery or radiation, but has not spread beyond the prostate region or the pelvic lymph nodes. LowIndigo describes situations in which there is no spread of the disease into the pelvic lymph nodes and BasicIndigo describes when there is suspected spread. HighIndigo, on the other hand, describes situations in which there is proven spread to the pelvic lymph nodes. This is determined by the use of scans or less often by detection during surgery.

1:48 HighIndigo is the lowest stage of prostate cancer in which there is proven spread of the disease beyond the prostate. While the situation is dangerous, it is not as serious as in cases where it has spread to the bones or to other lymph nodes beyond the pelvis. With aggressive treatment, most men with HighIndigo stage prostate cancer will achieve a long remission and many can still be cured.

3:07 In the past, the use of radiation on the lymph nodes was very dangerous because the technology was too primitive to target the lymph nodes exclusively and avoid the intestines and the negative effects that come with irradiating healthy tissue. Now, however, that risk has been almost totally eliminated assuming the radiation is administered at a center of excellence using the modern equipment

3:52 Radiation is effective at killing cancer in the pelvic lymph nodes, however, the proven spread of cancer to the lymph nodes suggests a high chance of the presence of undetectable micrometastases elsewhere in the body and so systematic treatments that treat the whole body, like hormone blockade, are necessary for optimal results. The typical hormone therapy regimen for HighIndigo might be Lupron injections for 1218 months alongside a secondgeneration hormonal agent such as Zytiga or Xtandi to increase the anticancer effects.

4:52 In addition to hormone therapy and radiation, it is now more common to include 6 cycles of Taxotere, a mild form of chemotherapy (another systematic therapy), to the regimen for men with HighIndigo prostate cancer. Taxotere causes temporary hair loss and fatigue, but it has been demonstrated to improve cure rates. Radiation and chemotherapy cannot be given at the same time, and so typically radiation will be given first, chemotherapy will be given later, and hormone therapy will be given throughout the whole process.

6:48 HighIndigo is a dangerous situation and at this stage every effort within reason needs to be taken to stop the spread of the disease. Fortunately, studies show that if the proper measures are taken a majority of men will achieve long remissions and some will even be cured.

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