Prostate Cancer-Surgical in India

Types of Prostate Cancer

• Localized cancer –contained within the prostate

• Locally advanced cancer

• Recurrent cancer comes back after previous treatment

• Metastatic cancer – when the cancer has spread to other parts of the body.

Risk Factor for Prostate Cancer

• Age – the chances of having prostate cancer increase with advancing age

• Ethnicity- Black men more  likely to get prostate cancer

• Family history – having a first degree relative with prostate cancer increases the risk.

• Diet , obesity are also important contributing factors

Signs and Symptoms of Prostate Cancer

Clinically the patient presents with symptoms of

• Urination troubles like ,frequent urging , difficulty in commencing urination , blood in urine

• Excess level of PSA (protein specific antigen ) in blood

• Bone fractures seen in  metastatic cases of cancer prostate

• There may be urinary /fecal incontinence in advanced cases

Tests and Diagnosis for Prostate Cancer

• Medical health  history of the patient taken into account

• Prostate cancer is commonly detected  by PSA (prostate specific antigen ) test of blood

• DRE – Digital Rectal Examination and  Trans rectal ultrasound also performed which aid diagnosis

• Biopsy is usually performed to confirm diagnosis

• To determine the stage of cancer , imaging studies like bone CT scan or MRI  scan

Treatment of Prostate Cancer

• Depends on the spread of cancer in the prostate gland
• In early stages the aim of treatment is cure
• In advanced stages the aim is to expand life and relieve symptoms
• Health and age of patient

Active surveillance – screening at regular intervals to closely monitor the state of patients prostate, without immediate treatment .

Surgery – the main benefit of surgery is the prostate with the cancer is removed .

Prostatectomy usually performed for:

• Clinically Localized cancer

• If age young and fast growing tumor

• Here  the surgeon removes the entire prostate gland and may remove surrounding tissues , lymph nodes and the seminal vesicles .

• Taking out lymph node reduces the risk of cancer recurrence .

• It may be performed laparoscopic ally or by open approach .

After surgery

• Monitoring in recovery

• Drain put for excess fluids

• Catheter put in

• Stocking and pumps to reduce the risk of clot formation

• In 7-10 days cystogram performed and catheter removed

• Within 2-4 weeks return to normal activities

• Medication given to help erection

Risks associated with surgery

• Infection

• Blood clots

• Damage to nearby organs

• Erectile dysfunction

• Urinary incontinence

Radiation - This therapy uses high energy beams of X- rays to treat prostate cancer by damaging the cells . It is useful in cases when :

• When cancer is low grade and limited locally to the prostate

• As treatment of choice along with hormonal therapy for cancer that has grown into surrounding tissue

• For cancer that recurs

• For metatstatic advanced cancers for palliative relief

Two Main Types of Radiation Therapy

• Brachytherapy – also called seed implantation , herein small radioactive pellets are placed on prostateand they give off their radiation at low dose over several weeks or months .
• External beam radiation also known as EBRT in which beams are focused on prostate from outside the body .

After effects of Radiation:

• Bowel problems –diarrhoea , blood in stool

• Urinary symptoms – radiation cystitis , urinary incontinence

• Erection problems

• Fatigue

• Lymphedema

Hormonal therapy –

• Does not cure , it’s a temporary therapy  and  just slows the cancer  growth or used as palliative therapy in metatstatic cases .

• It  aims to decrease production or block action of  testosterone , which leads to destroyed prostate cancer cells and shrunk prostate tumor ,

• Hormone therapy can be given alone or combination with other treatment .

Types of hormone therapy

• Orchiectomy : Surgical removal of testicles
• Drug therapy : block signal from brain thus lower testosterone , effects may be reversible
  • LH-RH Analogue therapy- blocks the production of testosterone .
  • Anti androgen therapy -blocks action of  testosterone  used before LHRH therapy to prevent androgen flare .

After Effects of Hormonal Therapy

• Hot flushes
• Reduced sex drive
• Decreased ability to have erections
• Fatigue
• Decresed muscle strength
• Can cause bone thinning
• Can lead to dyslipidaemia

Factors Affecting Cost Of Prostate Cancer Surgery

The cost to the patient depends on a variety of factors like

• The hospital, the patient chooses.
• Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service).
• Fee for the team of doctors.
• Medicines.
• Standard tests and diagnostic procedures.
• Type of surgery performed
•  cost of Radiation /Hormone therapy
• Cost of the follow –up care required after the procedure

Prostate Cancer Treatment: 2.34 Min