Prostate Cancer Surgery in India

Overview:

Prostate Cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer. According to the American Cancer Society's most recent estimates that deaths from Prostate Cancer has tolled to 27,360 on a yearly basis in the country. As reflected in these numbers, prostate cancer is likely to impact the lives of a significant proportion of men that are alive today. Over the years, however, the death rate from this disease has shown a steady decline, and currently, more than 2 million men in the U.S. are still alive after being diagnosed with Prostate Cancer at some point in their lives. Although it is subject to some controversy, many experts in this field, therefore, recommend that beginning at age 40, all men should undergo screening for prostate cancer.

What is Prostate Cancer?

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.

Types of Prostate Cancer

There are many types of prostate cancer and the condition is often present in many different parts of the prostate. The precursor to prostate cancer is known as prostatic intraepithelial neoplasia, this is also found in many different locations within the prostate. Although there are many different kinds of prostate cancer the vast majority (around 95%) are of the type known as adenocarcinoma. As this is the most wide spread from it has become synonymous with the term prostrate cancer.

• Adenocarcinoma: The most common site of origin of prostate cancer is in the peripheral zone (the main glandular zone of the prostate). The term adenocarcinoma can be split up to derive its meaning. Adeno means ‘pertaining to a gland’, whilst Carcinoma relates to a cancer that develops in epithelial cells. The term epithelial simply relates to cells that surround body organs or glands. Aldara and basal cell carcinoma
  
  

• Small cell carcinoma: This kind of cancer is made up of small round cells, and typically forms at nerve cells. Small cell carcinoma is very aggressive in nature and as it does not lead to an increase in prostate specific antigens it can be somewhat harder to detect than adenocarcinoma; this usually means that it has reached an advanced form upon detection.
  
  

• S quamous cell carcinoma: This is a non glandular cancer, like small cell carcinoma there is no increase in prostate specific antigens when this is present. Squamous cell carcinoma is very aggressive in nature. There are other, more rare, forms of prostate cancer these include sarcomas and transitional cell carcinoma; the latter rarely develops in the prostate but derives from primary tumours present in the bladder or urethra.

Causes of Prostate Cancer

The specific causes of Prostate Cancer remain unknown. The primary risk factors are age and family history. Prostate cancer is very uncommon in men younger than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70. However, many men never know they have prostate cancer. Men who have first-degree family members with prostate cancer appear to have doubled the risk of getting the disease compared to men without prostate cancer in the family. This risk appears to be greater for men with an affected brother than for men with an affected father.

Symptoms of Prostate Cancer

Because of the prostate's location in the body, prostate cancer is often accompanied by a number of unique symptoms. As the prostate enlarges due to cancer or another problem, the urethra is pinched tighter and tighter within the prostate. As the tube narrows, urine has a much harder time making its way through the urethra and out of the body. This results in four primary urinary symptoms:

• Frequency - urinating much more often than normal
• Urgency - having a sensation that you need to urinate immediately.
• Nocturia - getting up to urinate multiple times during the night.
• Hesitancy - difficulty starting the urine stream.

All of these symptoms are a direct result of the urethra being pinched closed by the enlarged prostate. Other less common symptoms include:

• Blood in the urine
• Blood in the semen
• New-onset erectile dysfunction (impotence)
• Bone pain (especially in the lower back, hips, or ribs)
• Loss of bladder control

These symptoms are less specific to problems with the prostate (meaning that problems with other organs such as the bladder can also cause them). However, they are important symptoms of which to be aware.

Diagnosis for Prostate Cancer

If Prostate cancer is diagnosed from the results of a biopsy of the prostate gland. If the digital rectal exam of the prostate or the PSA blood test is abnormal, a prostate cancer is suspected. A biopsy of the prostate is usually then recommended. The biopsy is done from the rectum (trans-rectally) and is guided by ultrasound images of the area. A small piece of prostate tissue is withdrawn through a cutting needle. The TRUS-guided Tru-Cut biopsy is currently the standard method to diagnose prostate cancer. Although initially a 6-core set was the standard, currently most experts advocate sampling a minimum of 10-12 pieces of the prostate to improve the chances of detection of the cancer and also to provide a better idea regarding the extent and areas of involvement within the prostate. Multiple pieces are taken by sampling the base, apex, and mid gland on each side of the gland. More cores may be sampled to increase the yield, especially in larger glands. A pathologist, a specialist physician who analyzes tissue samples under a microscope, then examines the pieces under the microscope to assess the type of cancer present in the prostate and the extent of involvement of the prostate with the tumor. Another very important assessment that the pathologist makes form the specimen is the grade (Gleason's score) of the tumor. This indicates how different the cancer cells are from normal prostate tissue. A Gleason score of 6 is supposed to indicate low-grade (less aggressive) disease while that of 8-10 demonstrates high grade (more aggressive) cancer; 7 is regarded as somewhere in between these two.

Prostate Cancer Staging

Prostate cancer is staged according to the pathological findings from biopsy. Staging is a method to describe how advanced a cancer is. Prostate Cancer Staging is done in the following ways:

• Stage I (or A): The cancer cannot be felt on a digital rectal exam, and there is no evidence that it has spread outside the prostate. These are often found incidentally after surgery for an enlarged prostate.
• Stage II (or B): The tumor is larger than a stage I and can be felt on a digital rectal exam. There is no evidence that the cancer has spread outside the prostate. These are usually found on a biopsy when a man has an elevated PSA level.
• Stage III (or C): The cancer has invaded other tissues neighboring the prostate
• Stage IV (or D): The cancer has spread to lymph nodes or to other organs

Preparing for Prostate Cancer Surgery

Preparing for surgery can be an immensely stressful time. You can try the following tips given as under:

Ask your doctor every question you have about the surgery, its potential complications, possible alternatives to surgery, and what you should expect in the days and weeks afterward. No topic or question is too small of an issue to discuss with your doctor.

Arrange everything with work, child care, family obligations, and every other part of your life well in advance of the scheduled surgery date. This will help you relax and will allow you more rest after surgery.

Having a positive attitude before and after surgery can go a long way towards easing your nerves beforehand and helping you get back to normal life afterward.

Your surgery has a set of known possible complications and your doctor can help you understand how likely any of these are to happen. It is important to start thinking about life after surgery, especially with regard to some of the more common complications.

Talking to others who have undergone the same or similar surgery can really help alleviate unfounded fears as well as prepare you for things that you might not have expected.

Stay active and healthy until surgery. Maintain a healthy, active lifestyle is important right up until the time of surgery.

Common Procedures of Prostate Cancer Surgery

The following are the common procedure for Prostate Cancer Surgery:

Radical Prostatectomy: This procedure is the most common Prostate Cancer Surgery and is used when there is a reasonable likelihood of curing the disease. It is used in younger, healthy patients with Stage A, Stage B, and some surgeons believe in some early Stage C prostate cancers. There are two types of Radical prostatectomy: Retropubic prostatectomy where the surgical procedure is to remove the prostate through an incision (cut) in the abdominal wall. Whereas the second one is perineal prostatectomy, wherein a surgical procedure removes the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). The operation involves removing the entire prostate, the seminal vesicles, (the organs that produce seminal fluid and are attached to the prostate), and reconnecting the bladder to the urethra, so that the patient may void normally. The open operations take 2 to 4 hours and require a 3 to 5 day hospital stay. The procedures when done through a laparoscope, it takes a significantly longer time, but the hospital stay is often reduced to a day or so. The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor. The disadvantages may include impotence, the inability to get or sustain an erection.

Orchiectomy: It is also known as surgical castration or orchidectomy and entails the removal of a man’s testicles. Orchiectomy is a type or prostate cancer hormone therapy which is nonreversible. Historically, orchiectomy was the only type of hormone therapy available for the treatment of prostate cancer; hormone therapy, therefore was used only after every other treatment option has been exhausted. Orchiectomy is still used today due to both cost and side effects. Orchiectomy is less expensive than chemical castration through the LHRH agonist and LHRH antagonist. Many men also find that the side effects of orchiectomy are also fewer and less severe than those of chemical castration. The orchiectomy operation is fairly simple and takes around 30 minutes to perform; the patient can usually go home on the same day and is treated as an out-patient. The patient is first given a choice of anaesthetic (either a general or local). The surgeon will then make a 3 to 5cm incision at the front of the scrota sac. The testicles are then pulled out and the spermatic cords are then cut. The insertion is then stitched up. Having an orchiectomy means that one does not need to have repeated injections of hormones to lower testosterone levels. In men with metastatic prostate cancer pain relief can occur very quickly; this normally takes about a month if receiving hormonal LHRH agonists. A major problem with orchiectomy is that it can have many psychological impacts upon a man; this can often be overcome by having implants or by the performance of a sub capsular orchiectomy.

Transurethral Resection of the Prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness. TURP is a type of transurethral surgery that does not involve an external incision. The surgeon reaches the prostate by inserting an instrument through the urethra. In addition to TURP, two other types of transurethral surgery are commonly performed, transurethral incision of the prostate (TUIP), and transurethral laser incision of the prostate (TULIP). The TUIP procedure widens the urethra by making small cuts in the bladder neck (where the urethra and bladder meet), and in the prostate gland itself. In TULIP, a laser beam directed through the urethra melts the tissue. The actual TURP procedure is simple. It is performed under general or local anesthesia. After an IV is inserted, the surgeon first examines the patient with a cystoscope, an instrument that allows him or her to see inside the bladder. The surgeon then inserts a device up the urethra via the penis opening, and removes the excess capsule material that has been restricting the flow of urine. The density of the normal prostate differs from that of the restricting capsule, making it relatively easy for the surgeon to tell exactly how much to remove. After excising the capsule material, the surgeon inserts a catheter into the bladder through the urethra for the subsequent withdrawal of urine.

Cryosurgery: Or Cryotherapy is a way of treating Prostate Cancer that uses freezing and thawing to kill the cancer cells in the prostate gland. It is commonly referred as cryotherapy and cryoablation. It is done using a number of thin needles (cryoneedles) which are inserted into the prostate gland under anaesthetic. This process kills both normal cells and cancer cells within the gland. The treatment involves getting the right balance between freezing the whole prostate gland, to kill all the cancer cells, and protecting healthy parts of the gland and surrounding tissues to avoid damaging them. Throughout the cryosurgery procedure, temperature sensors are used to allow physicians to determine when target temperatures have been reached. The cancer tumor and its blood supply are destroyed and the dead tissue is re-absorbed or remains in the body as harmless scar tissue. The benefits for these procedures are that it is an effective primary treatment for those who are in the early stages of prostate cancer with low risk for tumor extension. This treatment is also being an excellent alternative for those who are not good candidates for radical prostatectomy. Cryosurgery may be used if EBRT fails and the cancerous prostate cells are deemed radio-resistant. While other advantages includes the one day in-hospital treatment, though some patients will stay overnight depending on their general health. There have been improvements in cryotherapy in recent years, which have reduced the risk of side effects and improved the success of the treatment.

Post Operative Care after Prostate Cancer Surgery

To make sure you heal fast, after your Prostate Cancer Surgery, it's helpful to know about some self-care you can do at home. Note, however, that these are general guidelines and may not apply to every patient. Always follow your doctor's specific instructions for care after treatment.

• Incision Care: Small pieces of tape (called Steri-Strips) will remain over the incision site and may be removed 10 to 14 days after surgery. The incision should be kept clean and dry for one week after surgery. Take sponge baths instead of showers. Do not go swimming until you have discussed this with your doctor at your follow-up appointment.
  
• Pain Relief: You will be given a prescription for pain relief after the procedure. You can also take Extra Strength Tylenol if that provides enough relief. Do not take aspirin or products containing aspirin for the first three days after the procedure.
• Skin Care: The area may be black and blue right after the procedure. This will go away in a few days. You may feel numbness, tingling, or discomfort. This is normal. For pain; you can take a mild pain reliever such as Tylenol. One week after surgery, you can take a warm shower, which may also provide comfort.
  
• Exercise: Consult your doctor before resuming any physical activity.
• Driving: Most men can resume driving 10 to 14 days after surgery. Ask your doctor for specific advice.
• Sexual Relations: Your doctor will let you know when you can resume having sex.

Recovering After Prostate Cancer Surgery

In the case of a patient having undergone Prostate Cancer Surgery, the time to be spent in the hospital depends largely on the nature of the surgery and the condition of his health after the surgery. In the Prostate Cancer Surgery recovery, the catheter will be used for holding the urine of the patient till the track of urine becomes completely okay. You may be prescribed the pain killer medicines for proper recovery from the surgical procedure. After the improvement in control of urine and the reduction in the problem of swelling, you will be advised by your doctors to do light exercises. These light exercises will improve the circulation of blood to all the parts of your body. The prostate surgery recovery will be faster if the patient follows the vital instructions such as refraining from lifting heavy objects for a few months, maintaining a good and healthy diet with fruits, fruit juices and drinking water in adequate quantities. Though there are many prostate surgery side effects such as bowel dysfunction, urinary dysfunction, pain, bleeding, premature ejaculation, erectile dysfunction and infertility, this surgery has helped many people to lead a normal life by reducing the risk of prostate cancer.

Advance Prostate Cancer Surgery

High Intensity Focused Ultrasound (HIFU): HIFU is a highly precise medical procedure that targets tissue deep inside the body and destroys it using the power of ultrasound waves. This therapy, which is used to treat a variety of conditions including kidney cancer, uterine fibroids, breast cancer, and several other conditions, has recently caught the attention of the urology field as a highly effective, low-risk prostate cancer treatment option. When used to treat prostate cancer, HIFU begins with the administration of anesthetic, either spinal or general. Once the antistatic is in effect, the physician uses a Tran rectal probe to gather ultrasound images of the prostate gland. Through the probe, the physician will then deliver ultrasound waves directly into the prostate gland. HIFU offers less risk then other treatments with similar results. Because the treatment destroys the entire prostate gland, it is highly successful for localized prostate cancer cases. Because of the way the treatment works, tissues surrounding the prostate gland are not damaged, which lowers the risk of permanent conditions like impotence and incontinence, although these are still a risk as they are with any prostate cancer treatment option.

Prostate Cancer Surgery in India

India has been recognized as a new global medical destination for Prostate Cancer Surgery. Thousands of foreign patients from all across the world come to India for medical treatments and surgeries of high quality delivered as practiced in the developed nations like the US, UK and that too within their budget costs.

The Indian Oncologists performing different procedures of Prostate Cancer Surgery in India are highly qualified, skilled with many years of experience and are affiliated with many renowned medical organizations. India provides the services through most leading doctors and Prostate Cancer Surgery surgeons.

The Cancer Hospitals in India are well equipped with the most advanced medical treatment and methodologies. They have the most extensive diagnostic and imaging facilities including Asia’s most advanced MRI and CT technology. These are available in the following cities at reasonable costs in the following cities:

Cost of Prostate Cancer Surgery in India

India offers incredible cost saving in various procedures of Prostate Cancer Surgery, which goes to around 80% less than prevailing USA or UK rates. Even with travel expenses taken into account, the comprehensive medical tourism packages still provide a savings measured in the thousands of dollars for major procedures. A cost comparison of various medical treatments can give you the exact idea about the difference:

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