BY MARK SCHOLZ, MD Every year, 200,000 men are diagnosed with prostate cancer. Confusion about optimal treatment is widespread. The doctors even defer to their patients saying, “Since it’s about …
Royal (Hormonal-Resistance or Metastases Outside the Pelvic Nodes) is what defines Royal. Low-Royal is “pure” hormone resistance without any proven metastases. Hormonal resistance is defined as a rising PSA with a testosterone level less than 50. Basic- or High-Royal means that metastases outside of the pelvic nodes are proven to exist. With Basic-Royal the total number of metastases is five or less. Men with High-Royal have more than five metastases. Clearly, the likelihood of detecting metastases is influenced by searching with the best available type of scan. PET scans, for example, may convert men who were thought to be “Low-Royal” using an older type of scan technology to Basic- or High-Royal.
Treatment recommendations for Royal can vary widely because doctors are struggling to digest the explosion of new knowledge. Better treatments, improved scans and a deeper understanding of staging, genetics and immunotherapy have all conspired to complicate and increase the controversy about how to select optimal therapy. Overall, however, we can certainly be thankful for these breakthroughs and the additional discoveries that are coming in the near future.