Men in this category have recurrent or persistent disease after previous local therapy as defined by a persistent or rising PSA, a positive biopsy after surgery or radiation, a nodule felt on digital rectal examination or documented spread to pelvic lymph nodes.
Unlike other cancers, a relapse does not invariably portend early death. Statistics show that with Indigo, most men die of natural causes due to old age, not prostate cancer. This heartening fact results from three unique aspects of prostate cancer: Its slow growth rate, the surprising effectiveness of Testosterone Inactivating Pharmaceuticals (TIP) which induces remissions averaging over ten years, and, because prostate cancer typically does not spread to critical organs like lung, brain or liver.
Men in Indigo have a number of treatment choices: Observation, radiation, TIP, Angiogenesis inhibitors, Immunotherapy or some combination thereof. The rate of PSA rise, how quickly it doubles, provides an important indicator for selecting treatment intensity. PSA doubling in less than six months argues for combination therapy; between 6 and 12 months, moderate intensity therapy; between 12 and 18 months, mild intensity therapy. Men with PSA doubling times greater than 18 months are usually treated with observation.
Intermittent TIP has been the mainstay of treatment for Indigo. TIP is usually administered for eight to twelve months assuming the PSA drops to less than 0.1. After TIP is stopped and testosterone recovers the PSA is allowed to rise. TIP is restarted when the PSA reaches an arbitrary threshold, say between three and six.