Prostate Cancer Treatment Options in India

If prostate cancer is found at an early stage, is growing slowly, and treating the cancer would cause more discomfort than the disease, a doctor may recommend active surveillance or watchful waiting. During active surveillance, the cancer is monitored closely with regular PSA tests, DRE tests, and watching for symptoms with periodic biopsies. Active treatment only begins if the tumor shows signs of becoming more aggressive or spreading, causes pain, or blocks the urinary tract. Active surveillance is usually preferred for men with a long life expectancy who may benefit from curative local therapy if the cancer shows signs of getting worse.

Watchful waiting involves less intensive monitoring with periodic PSA tests, DRE tests, and/or watching for symptoms. It is usually recommended for much older patients or those with other serious or life-threatening illnesses. If the cancer shows signs of getting worse, hormone therapy is often recommended to treat symptoms.

Real caution must be taken not to make errors of judgment about the disease. In other words, doctors must collect as much information as possible about the patient’s other illnesses and life expectancy so the chance to detect an early, aggressive prostate cancer is not missed. For this reason, many doctors recommend a repeat biopsy shortly after diagnosis to confirm that the cancer is in an early stage and growing slowly before considering active surveillance for an otherwise healthy man. New information is becoming available all the time, and it is important for men to discuss these issues with their doctor to make the best decisions about treatment.

Surgery -Surgery is the removal of the tumor and surrounding tissue during an operation. It is used to try to eliminate a tumor before it spreads outside the prostate. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For prostate cancer, a urologist or urologic oncologist is the surgical oncologist involved in treatment. The type of surgery depends on the stage of the disease, the man’s general health, and other factors. Surgical options include:

Radical (open) prostatectomy - A radical prostatectomy is the surgical removal of the entire prostate and seminal vesicles. Lymph nodes in the pelvic area may also be removed. This operation has the risk of interfering with sexual function. Nerve-sparing surgery, when possible, increases the chance that a man can maintain his sexual function after surgery by avoiding surgical damage to the nerves that allow erections and orgasm to occur. Orgasm can occur even if some nerves are cut since these are two separate processes. Urinary incontinence is also a possible side effect of radical prostatectomy. To help resume normal sexual function, men can receive drugs, penile implants, or injections. Sometimes, another surgery can fix urinary incontinence.

Robotic or laparoscopic prostatectomy - This type of surgery is possibly much less invasive than a radical prostatectomy and may shorten recovery time. A camera and instruments are inserted through small, keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to remove the prostate gland and surrounding tissue. In general, robotic prostatectomy causes less bleeding and less pain, but the sexual and urinary side effects can be similar to a radical (open) prostatectomy. This procedure has not been available for as long as radical (open) prostatectomy, so longer-term follow-up information, including permanent cure rates, are not yet certain. Talk with your doctor about whether your treatment center offers this procedure and how it compares with the results of the conventional radical (open) prostatectomy.

Transurethral resection of the prostate (TURP) - TURP is most often used to relieve symptoms of a urinary blockage, not to treat prostate cancer. In this procedure, with the patient under a full anesthesia, which is medication to block the awareness of pain, a surgeon inserts a narrow tube with a cutting device called a cystoscope into the urethra and then into the prostate to remove prostate tissue.

Radiation therapy-  Radiation therapy is the use of high-energy rays to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

External-beam radiation therapy - External-beam radiation therapy focuses a beam of radiation on the area with the cancer. Some cancer centers use conformal radiation therapy (CRT), in which computers help precisely map the location and shape of the cancer. CRT reduces radiation damage to healthy tissues and organs around the tumor by directing the radiation therapy beam from different directions to focus the dose on the tumor. External-beam radiation therapy is usually given with a high-energy x-ray beam. It can also be given with proton therapy, which is described below. 

Advanced Prostate Cancer Treatment - Laser Surgery for Prostate Cancer in India

 Prostate Cancer Treatment

Prostate is a reproductive gland in males; it is relatively small organ and is located under the bladder. Prostate cancer is caused by the uncontrolled division of mutated prostate cells. These cancer cells form a tumor and obstruct the normal function of the prostate and the bladder.

It is rare in men younger than 40. Risk factors for developing prostate cancer include being over 65 years of age, family history and some genetic changes.

Symptoms of Enlarged Prostate may include

Problems in Passing urine, such as pain, difficulty starting or stopping the stream, or dribbling.

• Low Back Pain.
• Pain with Ejaculation.
• Blood in the Urine.
• Blood in the Semen.
• Swelling in the Legs.

How Prostate Cancer is Diagnosed?

• Prostate-Specific Antigen (PSA) Test : A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream but if the value increases, the cause must be located.
• Ultrasound : If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. This gives a clear picture of the prostate gland.
• Bone Scans and X-rays : It may reveal whether the cancer has invaded the bones. To perform a bone scan, doctors inject low doses of a radioactive substance into the patient's vein, which accumulates in bones that have been damaged by cancer.
• Digital Rectal Exam (DRE): During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. It helps to detect any structural anomalies in the prostate.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Scans : They can further pinpoint the location of cancer that has spread beyond the prostate.
• Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will check the biopsy sample to see if there are cancer cells and find out the Gleason score.

Treatments for Prostate Cancer

Every year thousands of International Patient choose India for the treatment of prostate cancer due the world class radiation or laser facility, chemotherapy & surgical expertise of world’s best cancer surgeon in India. Various treatment methods are undertaken for treating prostate cancer in India.

Prostate Cancer Surgery

Surgery is generally the elimination of the malignant tumor and adjacent tissues during the process of operation. Because of the sensitivity and the location of the prostate region surgery may be turned into a difficult method. There are various surgical treatments available in the medical science for removing cancerous tumors.  Biopsy is one of the most effective methods.

Laser Surgery for  Prostate Cancer

• Green Light Laser PVP : Photoselective Vaporization of the Prostate (PVP), also known as the Green Light Laser, has emerged as the treatment of choice for most patients having surgery for BPH. It is minimally invasive in the sense that all the work to open the prostate channel is made through the penis, without an incision on the abdomen. 
  
  The obstructive prostate tissue is vaporized by the directed laser beam. This is done under spinal or general anesthesia. The advantages of this approach over the traditional TURP (transurethral resection of the prostate) are many :
  
  • Rapid urine flow improvement.
  • Quick return to normal activities.
  • Virtually bloodless procedure.
  • Outpatient procedure in otherwise healthy patients.
    
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Green Laser Treatment for Prostate Cancer in India

Green light laser surgery for the prostate refers to Photoselective Vaporization of the Prostate using a green light laser (also known as KTP laser). It is used in the treatment of Benign Prostatic Hyperplasia or more commonly known as enlargement of the prostate gland.

Green light laser treatment is a minimally invasive therapy that evaporates prostate tissue which is blocking the flow of urine from the bladder. It uses a unique high power laser energy which is selectively absorbed by blood within the prostate tissue which leads to vaporization and removal of the tissue, leading to an open channel for passage of urine. At the same time, the laser seals blood vessels beneath the area of vaporization which results in substantially less bleeding, compared to traditional traditional transurethral resection of prostate (TURP). There are much fewer side effects and recovery is much quicker.

Is Green Light Laser treatment suitable for all patients?

This treatment is suitable for almost all patients with prostate enlargement who require surgery or not responding to medical (drugs) therapy. Prostate drugs are initially prescribed to patients with enlargement but some patients will progress and will require surgery. Surgery is also needed in patients who have complications such as bladder infection, bladder stone, inability to pass urine (retention) or kidney failure.

As green light laser has the additional ability to control and decrease bleeding during surgery, it has advantage in patients who are taking blood thinning medications such as Aspirin or patients who are taking anti-coagulation drugs such as Warfarin.

How does this compare to a standard TURP operation?

For decades, the gold standard for treating BPH has been a transurethral resection of the prostate (TURP) operation. During a TURP, an electrical cutting loop is passed down a cystoscope to chip away the obstructive prostate from the inside to create an open channel. The green light laser technology has been improved over the years such that it may now be considered the new gold standard treatment because it combines the excellent long term results that one gets with traditional TURP, with some other advantages.

The advantages it has over a standard TURP are:

• Less bleeding during and after the procedure
• Less need for blood transfusion.
• Faster recovery
• Patients go home earlier.
• Earlier return to work.
• Patients can stay on blood thinning medications during surgery
• Some patients cannot come off their blood thinning medications because of their medical conditions.
• Green light laser surgery is ideal for these patients.
• Shorter (or even no) post-operative catheter time
• Catheter time is usually < 24 hours as compared to 2 to 3 days for standard TURP.
• Less risk of water intoxication
• In standard TURP operations, patients may absorb the irrigation fluid and become ‘water-intoxicated’ which can potentially be dangerous.
• In green light laser surgery, because opened blood vessels are quickly sealed, less fluid is absorbed through these vessels, hence reducing the risk of water intoxication.
• Potentially less risk of erectile dysfunction (ED)
• The reported rate of ED with laser surgery is < 1%, whereas in standard TURP, it is about 2% - 4%.

Frequently asked questions about Prostate Cancer !

How does prostate cancer compare with other cancers?

A non-smoking man is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined. In fact, a man is 35% more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer. 

Are some men more likely to be diagnosed with prostate cancer?

Older age, African American race, and a family history of the disease can all increase the likelihood of a man being diagnosed with the disease. 

As men increase in age, their risk of developing prostate cancer increases exponentially. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 14 for ages 60 to 69. About 60% of all prostate cancers are diagnosed in men over the age of 65 and 97% occur in men 50 years of age and older. 

African American men are 56% more likely to develop prostate cancer compared with Caucasian men and nearly 2.5 times as likely to die from the disease. Men with a single first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is highest in men whose family members were diagnosed before age 65. 

How curable is prostate cancer?

As with all cancers, "cure" rates for prostate cancer describe the percentage of patients likely remaining disease-free for a specific time. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free. 

Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high—nearly 100% of men diagnosed at this stage will be disease-free after five years. By contrast, in the 1970s, only 67% of men diagnosed with local or regional prostate cancer were disease-free after five years. 

What are the symptoms of prostate cancer?

If the cancer is caught at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms such as frequent, hesitant, or burning urination, difficulty in having an erection, or pain or stiffness in the lower back, hips or upper thighs. 

Because these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms. 

If there are no symptoms, how is prostate cancer detected?

Screening for prostate cancer can be performed in a physician’s office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE). 

How is prostate cancer treated?

There are a wide variety of treatment options available for men with prostate cancer, including surgery, radiation therapy, hormone therapy and chemotherapy, any or all of which might be used at different times depending on the stage of disease and the need for treatment. 

Consultation with all three types of prostate cancer specialists—a urologist, a radiation oncologist and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes.