Low-Royal occurs when a man who is Indigo develops a rising PSA while taking a Lupron-like drug, and the restaging body and bone scans are clear. Despite the clear scans, Lupron-resistance is a reliable sign that 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. 

Every effort should be made to find the cancer’s location because treatment can be focused more effectively and insurance coverage for FDA-approved treatments will be easier to obtain. Modern PET scans often detect metastases at a much earlier stage than standard CT scans or bone scans. Many doctors treat Low-Royal with a mild type of testosterone inactivating pharmaceutical (TIP) that is called Casodex. 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.

Unsuspecting Doctors and Patients

Doctors and patients are often unaware of the danger from postponing effective treatment. Why? A physician’s thinking may be clouded over 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 pseudo-reality. They feel healthy and their only problem is that the PSA is rising. However, it is like the calm before the storm. The pussycat is morphing into a tiger. Unfortunately, patients and doctors alike often fail to realize that a rising PSA with a low testosterone indicates that the patient is entering very dangerous territory.




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.