Early Hormonal Resistance | Royal
Low-Royal occurs when a man who is Indigo develops a rising PSA while taking a Lupron-like drug, and the re-staging PET scans are clear. Despite the clear scans, Lupron-resistance is a reliable sign that the cancer growth rate is accelerating. When Low-Royal is diagnosed, it should be looked upon as an opportunity to adopt an aggressive treatment protocol and deliver multiple treatment punches before the cancer further progresses and becomes more entrenched.
The first step: Every effort should be made to find the cancer’s location. Knowing the cancer’s location allows treatment to be focused more effectively and insurance coverage for FDA-approved treatments will be easier to obtain. PSMA scans detect metastases at a much earlier stage than CT scans or bone scans. Some doctors treat Low-Royal with a mild type of testosterone-inactivating pharmaceutical (TIP) that is called Casodex (bicalutamide). However, this may be ill-advised. Treatment with other FDA-approved, life-prolonging therapies ends up being postponed. Studies show that delaying life-prolonging therapy impairs treatment results over the long term.
The second step: If body scans fail to disclose the location of the cancer, treatment with Zytiga, Erleada, Nubeqa, or Xtandi should be initiated. Well-performed randomized trials show that these effective medications will delay the development of bone metastases by several years. These oral medications are generally well tolerated, often with no side effects beyond what men normally experience with Lupron.
Unsuspecting Doctors and Patients
Doctors and patients are often unaware of the danger from postponing effective treatment in men with Low-Royal. Why? A physician’s thinking may be clouded by the many previous years of successful disease control with Lupron. They assume that the longstanding quiet behavior of the cancer will continue indefinitely into the future. Men with Low-Royal are in a strange situation. They feel healthy, and their only problem is that the PSA is rising. Unfortunately, patients and doctors alike often fail to realize that a rising PSA with low testosterone indicates that they are entering dangerous territory.
ABOUT THE AUTHOR
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.