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Prostate Cancer

Prostate cancer is the 4th most prevalent cancer in the world with 1.41 million cases according to WHO.  Typically prostate cancer occurs in old age and may not show any signs or symptoms in its early stages.

Detection of cancer itself is a matter of grave concern. However, with the advancement of technologies both in detection and treatment, the survival rates are also increasing. 

Let me introduce you, one of our patients Daniel Banda from Ibadan, Nigeria.

Daniel Banda is a 49-year-old and is the owner of a hotel in Ibadan. He has 2 kids and a wife. He is a very happy and humble personality, and is always forthcoming to help others. He loves outings with his family.  

Two years back, Daniel started to notice burning sensations while urinating. Moreover, he also felt that his urine stream had also decreased. 

He visited a local physician for a checkup. After a physical examination, the doctor suggested he do an ultrasound and a prostate-specific antigen (PSA) test. 

The next day when the report came, the PSA levels were surprisingly high. The doctor got suspicious and recommended further evaluation including biopsy.

After the biopsy result, the doctor informed Daniel that he has localized prostate cancer.

prostate cancer treatment in india
prostate and bladder medical vector illustration

After hearing the cancer news Daniel and his wife Abiola were in shock. His wife and kids supported him. The family wanted to undergo the best treatment for Daniel. His elder son started researching on the internet for the best treatment for prostate cancer. 

While looking for options in India, he got to understand the Tumour board, a new way of deciding treatment plans by a team of doctors including medical oncologists, surgical oncologists, and Radio Oncologist. He dropped an inquiry at the MedicoExperts website for a tumor board appointment. 

The MedicoExperts patient care department got in touch with Daniel’s family and arranged the video consultation with the Uro-oncologist, who heads the board for prostate. The doctor went through all the reports and took a day more to discuss with team members. A day later, the uro-oncologist shared the board view and the MedicoExperts patient care team passed the treatment plan with Daniel’s family. 

The family requested once again to interact with the Onco-Urologist who was heading the board. One more video call got scheduled for the next day. The doctor explained the plan and the reasons behind the plan in detail. He also clarified the doubts which the family was having.

Though the treatment plan was a bit different than the conventional plans, the Daniels family decided to go with the board’s recommendations.

MedicoExperts patient care team helped the family with visas and other logistics arrangements.

After 15 days, Daniel and his wife came to India for treatment. Daniel was admitted on the same day and an evaluation was performed to check the current condition. 

After the evaluation, the onco-surgeon performed the robotic-assisted radical prostatectomy to remove the impacted prostate along with cancerous tissues. 

After a few days, the doctor conducted the evaluation and there is no trace of cancer found. The doctor advised Daniel for the follow-up appointments and to do PSA testing for 6 months. The doctor did mention that there might be a need for radiation in case of the PSA levels increase.

Daniel and his wife were very happy with the results and thanked the doctor and MedicoExperts.

Daniel went back to Ibadan and MedicoExperts helped Daniel to connect with the doctor for the follow-up through video consultation. Fortunately, Daniel responded to the treatment very well and as per the doctor’s expectations, he came out without any additional therapy.

This can be your story as well to win the battle against prostate cancer. What you need is the right guidance, right treatment at the right time from the experts.

 Before we move ahead in our discussion, let’s understand what prostate cancer is.

Robotic-Prostatectomy-for-Prostate-Cancer-Treatment-in-india

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What is prostate cancer?

Prostate cancer is the type of cancer that affects the prostate. 

The prostate is a small nut-shaped gland in males that produces the seminal fluid that feeds and carries the semen.

Prostate cancer is one of the more prevalent types of cancer. Many prostate cancers develop slowly and limit themselves to the prostate gland, where they may not cause severe damage. However, in some cases, prostate cancer becomes aggressive and spreads quickly to other neighboring body parts.

Prostate cancer in its initial stages, confined to the prostate gland, and the patient has the best chance of success with minimal treatment and complications.

what is Prostate cancer
types of prostate cancer

Types of prostate cancer

Types of cancer that may occur in the prostate are

  • Adenocarcinoma: Most prostate cancers are adenocarcinoma. These cancers develop from the cells of the gland (the cells that form the liquid in the prostate that is added to the sperm).
  • Sarcomas: Soft tissue sarcomas are cancers that develop in the connective and supporting tissues of the body. Muscle, nerves, fat, fibrous tissue, and blood vessels are among these tissues.
  • Neuroendocrine tumors (except small cell carcinomas): Neuroendocrine tumors (NETs) are rare tumors that begin in the cells of the nervous system. NETs come in a variety of shapes and sizes. The type you have is determined by the type of cell in which cancer began.
  • Small cell carcinoma: Small round cells are responsible for small cell prostate cancer. It’s a type of cancer that affects the neuroendocrine system.
  • Transition cell carcinoma: Prostate transitional cell cancer begins in the cells that line the tube that transports urine to the outside of the body (the urethra). This cancer typically begins in the bladder and progresses to the prostate. It can, however, start in the prostate and spread to the bladder entrance and nearby tissues in rare cases.
  • There are a few other types of prostate cancer. If you are told that you have prostate cancer, it is quite certain that it is adenocarcinoma.

In some cases, prostate cancers develop and spread rapidly, but in most cases, it develops slowly.

prostate cancer symptoms

What are the signs and symptoms of prostate cancer?

If you experience any of the following symptoms, Please does consult your urologist immediately.

  • Difficulty in beginning urination.
  • Poor or discontinued urinary flow.
  • Frequently urinating, particularly at night.
  • Difficult to empty the bladder.
  • Painful or burning while urinating.
  • Blood from urine or semen.
  • Back, hip, or pelvic pain that does not go away.
  • Painful ejaculation.

If you are having one or more of these symptoms, don’t conclude on your own that you have cancer. However, don’t take these symptoms lightly as well. Meet the urologist and follow his advice with respect to further investigations.

prostate-cancer-symptoms

What are the stages of prostate cancer?

After the diagnosis of prostate cancer, the doctor will try to figure out the spread of cancer which is known as staging. The stage of prostate cancer refers to the spread of cancer in the body. Your treatment plan also depends upon the stage of prostate cancer.

Before we begin with the staging let’s understand a few terminologies

The most widely used staging system for prostate cancer is the AJCC (American Joint Committee on Cancer) TNM (tumor (T), nodes (N), and metastases (M)) system.

The Grade Group (based on the Gleason score), which indicates how quickly the cancer is likely to grow and spread. The results of the prostate biopsy determine this (or surgery).

Prostate cancer is classified into four stages: I, II, III, and IV. Some stages are further divided (A, B, etc). The lower the number, the less cancer has spread in general. A higher number, such as stage IV, indicates that cancer has progressed further.

Stage I

Prostate cancer is growing, but it hasn’t spread beyond it. 

In most cases, the doctor won’t be able to feel or see the tumor during a DRE or imaging tests. 

The tumor covers half of one side of the prostate or less.

  • The PSA level is less than 10 
  • The Gleason score is 6 or less

Stage IIA

The prostate cancer is growing, but it hasn’t spread beyond it.

During a DRE, the doctor might or might not be able to feel the tumor or see it on an imaging test. The tumor can affect more than half of one of the prostate’s lobes but not both.

  • The PSA level is less than 20
  • The Gleason score is 7 or less

Stage IIB

The prostate cancer is growing, but it hasn’t spread beyond it.

During a DRE, the doctor might or might not be able to feel the tumor or see it on an imaging test. The tumor can be found in one or both of the prostate’s lobes.

  • The PSA level is less than 20
  • The Gleason score is 7

Stage IIC

The cancer hasn’t spread beyond the prostate. During a DRE, the doctor might or might not be able to feel the tumour or see it on an imaging test. The tumor can be found in one or both of the prostate’s lobes.

  • The PSA level is less than 20
  • The Gleason score is 7 or 8

In comparison to stage IIB, the cancer cells appear to be more abnormal.

Stage IIIA

The cancer hasn’t spread outside the prostate. During a DRE, the doctor might or might not be able to feel the tumor or see it on an imaging test. No lymph nodes have been affected by the cancer.

  • The PSA level is at least 20
  • The Gleason score is 8 or less

Stage IIIB

The cancer has spread outside the prostate, but it hasn’t reached the lymph nodes or other distant parts of the body.

  • The PSA is any level
  • The Gleason score is 8, or less

Stage IIIC

The cancer may or may not have spread outside the prostate. No lymph nodes have been affected by the cancer. 

  • The PSA is any level
  • The Gleason score is 9 or 10

Stage IVA

The cancer may or may not have spread to tissues near the prostate. Although the cancer has spread to nearby lymph nodes, it has not spread to other parts of the body.

  • The PSA is any value
  • The Gleason score is any value

Stage IVB

The cancer may or may not have spread to nearby tissues or lymph nodes. The cancer has spread to other parts of the body, including lymph nodes, bones, and organs.

  • The PSA is any value
  • The Gleason score is any value 

Prostate cancer staging is a bit complex. Your oncologist is the best person to conclude what is the stage of your cancer. 

3d-virus-cells-attacking-dna-strand_1048-6816

Causes

What are the causes of prostate cancer?

The exact cause of prostate cancer is unknown.

According to doctors, Prostate cancer develops when cells in the prostate develop changes in their DNA. The DNA of a cell contains the instructions that tell it what to do. The changes cause the cells to divide and grow at a faster rate than normal cells. When other cells die, abnormal cells continue to live.

The abnormal cells come together and form a tumor, which can spread and invade nearby tissue. Some abnormal cells can break away and spread(metastasize) to other parts of the body over time.

Some of the factors that increase the risk of prostate cancer were:

  • Old Age: As you get older, your chances of developing prostate cancer increase. After the age of 50, it becomes more common.
  • Race: Black people have a higher risk of prostate cancer than people of other races for unknown reasons. Prostate cancer is also more likely to be aggressive or advanced in Black men.
  • Family history: If a blood relative has been diagnosed with prostate cancer, such as a parent, sibling, or child, your risk may be increased. Additionally, if you have a strong family history of breast cancer or a gene that increases the risk of breast cancer (BRCA1 or BRCA2), your risk of prostate cancer may be higher.
  • Obesity: Obese people may have a higher risk of prostate cancer than people who are considered to be of normal weight, though studies have yielded mixed results. Obese people are more likely to have cancer that is more aggressive and that returns after treatment.

diagnosis

What are the tests to diagnose prostate cancer?

Prostate screening may include the following:

During a DRE, your physician inserts a gloved and lubricated finger into your rectum to examine your prostate, which is next to the rectum. If your doctor becomes aware of any abnormalities, you may need more tests.

A blood sample is taken from a vein in your arm and analyzed for PSA, a substance that is naturally generated by your prostate gland. It’s okay to have a small amount of PSA in your blood. However, if a higher than normal level is found, it can indicate prostate infection or cancer.

If this screening detects an abnormal condition, your doctor may recommend other tests to determine if you have prostate cancer, such as:

Ultrasound

In a transrectal ultrasound, a small tube of this size is inserted into the rectum. The catheter uses sound waves to create an image of your prostate gland.

Magnetic Resonance Imaging (MRI)

In certain situations, your doctor may recommend an MRI of the prostate for a more detailed image. MRI images can help your doctor plan a procedure to collect tissue from the prostate.

Collection of a specimen of prostate tissue

To determine if cancer cells are present in the prostate, your doctor may recommend a procedure to collect a sample of prostate cells (prostate biopsy). Prostate biopsies are often done using a fine needle inserted into the prostate to collect tissue. The tissue specimen is analyzed in the laboratory to determine the presence of cancer cells.

treatment

Prostate cancer treatment in India

Your options for treating prostate cancer depend on multiple factors, like the rate at which your cancer is growing,

if it has spread and your general health, along with the potential benefits or side effects of prostate cancer treatment.

Radical Prostatectomy Surgery: The surgical method to remove the prostate gland along with the nearby tissues is called radical prostatectomy surgery.

Surgery is an option to treat cancer that is contained in the prostate. It is occasionally used to treat advanced prostate cancer in conjunction with other prostate cancer treatments.

Robot-Assisted Prostatectomy Surgery: The surgical intervention of the removal of the prostate gland and the adjoining tissues by employing the use of highly advanced – robotic surgical technology is known as Robot-assisted prostatectomy surgery.

External beam radiation for prostate cancer

External radiation is an option for treating prostate-related cancer. It can also be used after surgery to kill cancer cells that may remain if the cancer is at risk of spreading or returning.

Radiation positioned inside your body (brachytherapy). 

Brachytherapy refers to placing radioactive sources in your prostate tissues. Most commonly, radiation is contained in radioactive seeds the size of rice that is inserted into the tissues of the prostate. The seeds produce a low radiation dose over a prolonged period. Brachytherapy is an option to treat cancer that did not extend past the prostate.

Ablative therapies kill prostatic tissue through cold or heat. Options can include:

Freezing prostate tissue

Cryoablation or cryotherapy of prostate cancer involves using very cold gas to freeze prostatic tissue. Freezing and defrosting cycles kill cancer cells and certain healthy tissues that surround them.

Heating prostate tissue

High-Intensity Focused Ultrasound (HIFU) uses concentrated ultrasound energy to heat the prostate tissue and cause its death.

Hormonal therapy is a treatment to prevent your body from producing male testosterone hormone. Prostate cancer cells are dependent upon testosterone for growth. Cutting down on testosterone supply can cause cancer cells to die or grow more slowly.

Chemotherapy uses medications to kill cells that develop quickly, including cancer cells. Chemotherapy can be given via a vein in your arm in the form of a pill or both.

Immunotherapy uses your immune system in the fight against cancer. The immune system of your body may not attack your cancer, as cancer cells produce proteins that help them hide from the cells of the immune system. Immuno-therapy acts by interfering with this process.

Targeted drug therapies focus on specific abnormalities in cancerous cells. By blocking these abnormalities, targeted medication treatments can cause the death of cancer cells.

 If hormone therapy is not effective, targeted therapeutic medications may be recommended for advanced or recurrent prostate cancer treatment.

A cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells.

Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs.

Radiofrequency ablation is an innovative treatment used to kill cancerous tissues using high-frequency radio waves and heat.

Prostate Cancer treatment explained by Dr. Pankaj Maheshwari

Listen to Dr. Pankaj Maheshwari speak about prostate enlargement, prostate cancer, and all you need to know is to be cautious.

He also answers all commonly asked questions regarding prostate enlargement, prostate cancer, and its treatment.

Dr. Pankaj Maheshwari is a renowned urologist and has over 23 years of expertise in handling urological cases.

He is one of the pioneers to initiate therapeutic flexible ureteroscopy in India.

prostate cancer treatment cost in India

How much does prostate cancer treatment cost in India?

The cost for prostate cancer treatment in India varies on the size of the tumor, stage of cancer, and also the treatment option is chosen according to the condition of the patient. A cancer evaluation will reveal the extent of the spread and the best-suited treatment to restrict and cure it. The cost for cancer evaluation starts from 500 USD (38000 INR).

After the initial evaluation, the oncologist will be able to gauge if cancer can be treated by therapy alone or if surgery is recommended. The cost for prostate cancer surgery in India starts from 4200 USD (319856 INR). Thanks to advancements in technology and innovation, newer and safer surgical options are also possible. Advanced cutting-edge surgery like Focal Laser Ablation and robot-assisted prostatectomy surgery is also available for an additional 10-20% of the standard surgery cost. However, it is to be noted that not every patient is eligible for this treatment option. The onco-surgeon will suggest the best-suited treatment plan based on the patient’s case.

In certain cases, surgery is also to be combined with other treatments like chemotherapy and radiation therapy to ensure a complete cure. The cost of chemotherapy starts from 400 USD / cycle (30462 INR).

Treatment cost

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prostate cancer survival rate

Success Rate

What is the survival rate of prostate cancer treatment in India?

A study in Mumbai showed that patients who underwent surgical prostate cancer treatment had a better survival rate (91%). These results show that although prostate cancer treatment can save a life or extend the number of years of survival, awareness, and prevention of the disease have become vital in our time.

 

 

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Frequently Asked Questions and patient concerns:

1. At what age does prostate cancer occur?

Prostate cancer is rare among men under the age of 40, but the probability of having prostate cancer increases rapidly after the age of 50. About 6 in 10 men over the age of 65 have prostate cancer.

2. What is the best fruit for the prostate?

Strawberries, blueberries, raspberries and mulberries are recommended for an expanded prostate diet. The prostate is controlled with potent hormones called sex hormones, including testosterone.

3. Is a PSA of 6.5 Bad?

PSA concentrations lower than 4 ng/ml are generally considered normal, while concentrations higher than 4 ng/ml are considered abnormal. PSA levels of 4 to 10 ng/ml indicate a higher-than-normal risk of prostate cancer. When PSA levels are more than 10 ng/ml, the risk of prostate cancer is much higher.

4. How long do you normally live with prostate cancer?

Nearly 100 percent of men with local or regional prostate cancer will survive more than five years after diagnosis. Few men (approximately 7%) have more advanced prostate cancer when diagnosed.

5. Can prostate cancer make itself go away?

Simply put, yes, prostate cancer can be cured when it is detected and treated quickly. The vast majority of prostate cancer cases (over 90%) are discovered early, making tumors more susceptible to response to prostate cancer treatment.

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