Treatment for Indigo varies per the subtype. Men with Low-Indigo are presumed to have disease confined to the prostate or where the prostate used to be located.  Men with Basic-Indigo are at significant risk for micro metastases in the pelvic nodes. Unequivocal pelvic node metastases are associated with High-Indigo. 

Low-Indigo is defined by: 1) clear scans, 2) a PSA doubling time over 8 months, 3) the absence of any seminal vesicle invasion or extracapsular extension, 4) if the PSA is rising, it is less than 0.5 after surgery and less than 5.0 after radiation, and 5) the original Stage of Blue prior to initial treatment was SkyLow-Teal or Basic-Teal. In men who relapse after surgery, the best chance for maintaining sexual function is to delay radiation or forgo it altogether. Men who relapse after radiation are typically treated with focal cryotherapy. Alternatively, they can consider salvage seed implantation or intermittent TIP. Men with doubling times over 12 months can consider observation alone without any immediate treatment. 

Basic-Indigo is defined as any one of the following, but without any proven disease in the pelvic nodes: 1) A PSA doubling time of less than 8 months, 2) Seminal vesicle invasion3) A rising PSA above 0.5 after surgery or above 5.0 after radiation, or 4) The original Stage of Blue was High-Teal or Azure. Men who had previous surgery are typically treated with IMRT to the prostate fossa and the pelvic lymph nodes along with TIP. Men who underwent previous radiation should receive TIP plus IMRT to the pelvic lymph nodes. Focal cryotherapy or salvage seeds are used for persistent disease in the prostate. 

High-Indigo is characterized by unequivocal pelvic node metastases and warrants multimodality therapy with long-term TIP (with Zytiga), IMRT to the nodes and Taxotere. 


ABOUT THE AUTHOR

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Mark Scholz, MD is the Executive Director of the Prostate Cancer Research Institute. He is also the Medical Director of Prostate Oncology Specialists Inc. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is co-author of Invasion of the Prostate Snatchers.  He has authored over 20 scientific publications related to the treatment of prostate cancer.

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