Prostate Cancer-Surgical and Cost 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

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

• 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

• 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

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  hormone, 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 hormone, effects may be reversible.
  • LH-RH Analogue therapy- blocks the production of hormone.
  • Anti Androgen Therapy- blocks action of  hormoneused 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