Prostate Cancer

Prostate Cancer


Prostate Cancer Treatment in India - Types of Prostate Cancer and Different Stages

The prostate is a small, ping-pong-sized, walnut-shaped gland that is present in front of the rectum and below the urinary bladder. It is only present in males and absent in females. The function of the prostate gland is to produce a seminal fluid that transports and nourishes the sperm. Cancer refers to the abnormal growth of the cells and prostate cancer refers to the abnormal growth of the cells in the prostate gland.

The abnormal cell growth results in the formation of a group or a mass of these cells which is referred to as tumors. The tumors are of two types: cancerous (also known as malignant) and non-cancerous (also known as benign). The benign tumors do not spread to the other parts of the body and they are not harmful but the malignant tumors can spread to the nearby tissues and organs like the rectum, urinary bladder, etc. and they may cause life-threatening complications in the body.

Prostate cancer is the 3rd most commonly diagnosed cancer in the world. Studies show that African men are more prone to prostate cancer as compared to other nations. The prostate cancer rates and deaths caused by prostate cancer in men are high in Africa due to the unavailability of early diagnosis and proper treatments. For instance, prostate cancer is most common in Uganda with an incidence rate of 41.6% per 100,000 population.

According to the Uganda Cancer Institute, most of the prostate cases diagnosed were at stage IV. This is due to an insufficient cancer care system in the country. Other than Uganda, in many low and middle-income countries, prostate cancer is diagnosed at an advanced stage because of ineffective, and expensive treatment procedures. Because of this reason, many African men from countries like Uganda, Congo, Rwanda, and Ghana travel to India for prostate cancer treatment.

As cancer treatment in India is reliable and far more affordable than in many other countries, they choose India over other nations. The Indian cancer hospitals provide innovative treatment options with the latest and modern infrastructure and facilities.

Oncologists in Indian hospitals have many many years of experience and can deliver the best treatment. The medical staff in the cancer institutes of India are highly collaborative and cooperative and provide 24-hour patient support. Africans have an extremely good experience with medical treatment in India and therefore trust getting their treatment in the country.

What Causes Prostate Cancer?

The exact cause of prostate cancer is not known, but several DNA mutations damage cells and make them spread quickly, killing other healthy cells as well. The factors that can trigger the growth of cancer cells in the prostate. They are:

  • Age: prostate cancer is commonly diagnosed in men above 50 years of age.
  • Ethnicity or Race: African American Men are more vulnerable to developing prostate cancer than any other race.
  • Hereditary: If a man has his first-degree relative having a history of prostate cancer, there are high chance he may develop it.
  • Genetics: You are most likely to develop prostate cancer if you have Lynch syndrome.
  • Obesity: Obese men are more likely to develop prostate cancer.
  • Sexual Infection: Sexually transmitted diseases increase the risk of prostate cancer.
  • Chemical Exposure: Men with exposure to carcinogenic chemicals like Cadmium are at a high risk of DNA mutations leading to prostate cancer.

Besides the above mentioned causes, there are some other factors that can cause prostate cancer. These include smoking, prostatitis, etc.

Symptoms of Prostate Cancer

The early stage of prostate cancer usually does not show any symptoms. The symptoms of prostate cancer develop slowly as the disease slowly progresses. Any abnormality in a prostate gland will lead to the following symptoms.

  • Frequent urination, mostly at night.
  • Weak urine flow (interrupted urine flow)
  • Blood in urine or blood in the semen, also known as hematospermia.
  • Fecal incontinence, which means loss of bowel control
  • Urinary incontinence, which means loss of urine control.
  • Lower back pain, chest pain, and hip pain.
  • Painful ejaculation

Prostate Cancer Stages

Prostate cancer is in an early stage if the cancer cells are only present in the prostate and have not spread to the nearby tissues and if the cancer has spread to the nearby tissues, it is an advanced stage of prostate cancer. Depending upon the spread of the cancer cells, there are four prostate cancer stage.

Stage I and Stage II prostate cancer:

These are considered early stages because the cancer is only in the prostate gland and has not spread to other parts of the body. It is also known as a localized stage of prostate cancer. prostate cancer is a slowly growing cancer and hence it does not quickly shift to the advanced stage of cancer.

Stage 3 prostate cancer:

It is also known as a locally advanced prostate cancer. When the cancer has spread a little bit to the nearby organs and tissues of the prostate, it is known as stage 3 prostate cancer.

Stage 4 prostate cancer:

It is known as an advanced stage of prostate cancer where the cancer has spread to the other organs and tissues of the body such as bones, liver, lungs, lymph nodes, etc. Advanced prostate cancer can also spread the cancer to the rectum, pelvic wall, and rectum.

Types of Prostate Cancer

There are many kinds of prostate cancer. The most common form of prostate cancer is adenocarcinoma, about 95% of people diagnosed with prostate cancer have this type. Depending on which cell has developed cancer, you may have one of these prostate cancer types.

1. Adenocarcinoma:

It is a cancer that forms in the cells of a prostate gland. These cells of the prostate gland produce the fluid that mixes with the sperm to make semen. If these cells become cancerous it is known as adenocarcinoma. There are two types.

2. Acinar adenocarcinoma:

This is the type that most people are diagnosed with. When the cancer forms in the cells that form the lining of the prostate gland it is known as acinar adenocarcinoma.

3. Ductal adenocarcinoma:

This is an aggressive form of male prostate cancer that occurs in the cells that form the lining of the ducts present in the prostate gland. It grows rapidly and spreads fast.

4. Transitional cell carcinoma:

It is also known as urothelial carcinoma. This type of prostate cancer starts from the cells that form the lining of the urethra (the tube/pipe that excretes the urine). This type of cancer starts from the urinary bladder and then spreads to the prostate gland and in very rare cases it starts from the prostate gland and spreads to the urethra and surrounding tissues. It is very rare and only 2 to 4% of people diagnosed with prostate cancer have this type.

5. Squamous cell carcinoma:

It is actually a skin cancer that starts from the prostate gland and then spreads to the skin. Only about 1% of people are diagnosed with this type of cancer.

6. Small cell carcinoma:

It is also known as neuroendocrine cancer. It grows faster than other types but is only diagnosed in about 1% of patients. This type of cancer starts in the prostate gland and then spreads to the lungs. It may also spread to the other organs in the body such as the liver, bones, etc. if early diagnosis is not done.

7. Neuroendocrine tumors:

Neuroendocrine cells are the ones that make the hormones in the organs these cells are present in such as the pancreas, lungs, stomach, etc. Neuroendocrine cancer starts in the digestive tract and then spreads to other organs. It rarely spreads in the prostate gland. Less than 1% of people are diagnosed with this cancer.

8. Soft tissue sarcoma:

This type of cancer starts from the supportive and connective tissues such as blood vessels, nerves, muscles, fat, etc., and then spreads to the different body organs. It very rarely spreads to the prostate gland. It affects less than 1% of men.

Diagnosis of Prostate Cancer

When you consult your doctor for the symptoms you are having, and if the doctor thinks that it may be due to prostate cancer then he may conduct the diagnostic tests to confirm the condition. The diagnosis of prostate cancer is done in 3 steps: first, the presence of prostate cancer is diagnosed, then whether the prostate cancer is aggressive or not is checked, and then whether it has spread to other body parts is checked. The different diagnostic steps for prostate cancer are mentioned below in detail.

1. Diagnosis to check the presence of prostate cancer

To check the presence of prostate cancer, your doctor will first conduct a physical examination and blood test, and then depending on the test result, further tests will be done. The diagnostic tests to determine if you have prostate cancer include:

Digital rectal exam (DRE): As the prostate gland is present in front of the rectum, we can examine the prostate gland through the rectum. For this, the doctor wears a glove, applies lubrication on the gloved finger, and inserts it into the patient’s rectum to check any abnormal shape, size, and texture of the prostate gland.

Prostate-specific antigen test (PSA): It is a blood test to determine any infection or inflammation in the prostate gland that may be due to cancer. In this test, the patient’s blood is analyzed for the presence of PSA. The PSA is normally present in the blood but it is in normal amounts. However, if the prostate is diseased, it produces a high amount of PSA.

Ultrasound test: This is an imaging test that uses sound waves to create an image of the organ under examination. In this test, an ultrasound probe is inserted into the rectum and the prostate gland’s image will be visible on the screen to check for any abnormalities.

Magnetic resonance imaging (MRI): By using an MRI scan, we can get a more detailed image of the prostate gland.

Prostate biopsy: To determine the presence of cancer cells, a biopsy is done where the tissue of the prostate gland is collected with a thin needle and sent to the lab for testing.

2. Tests to determine if the prostate cancer is aggressive

When the above mentioned tests confirm the presence of prostate cancer, the next step is to check how aggressive (grade) your cancer is. Following are the tests to check that.

Gleason score: It is a common test to determine the grade of prostate cancer. Based on the biopsy results, there are different grades of cells present in the cancer tissue, the most common grades are combined and the Gleason score. A score of 6 means low grade, 7 means medium grade, and 8 to 10 means high grade cancer.

Genomic testing: This test is not always performed, but it is a great tool to decide the treatment option. It is a test that determines the mutations in the genes of the prostate cells.

3. Diagnosis to check if the cancer has spread

Once the grade of cancer is determined, the final diagnostic step is to determine whether it has spread to other organs in the body. For this, the list of tests that your doctor might perform is given below:

  • Transrectal Ultrasound
  • Bone Scan
  • Computerized Tomography (CT scan)
  • Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA PET scan)
  • Transrectal Magnetic Resonance Imaging (MRI scan)

Treatment Options for Prostate Cancer in India

There are numerous treatment options for prostate cancer in India. Depending upon the grade and type of prostate cancer you have, the best management and treatment options will be recommended to you by your doctor. Your doctor may use a combination of the different treatments to treat your prostate cancer. The different treatments available in India for prostate cancer are as follows:-

Watchful waiting: This is an approach that is used for patients who have critical illnesses in the body and are not expected to live more than 5 years. For these patients, regular PSA tests and biopsies are not done and the treatment is only done if the patient suffers from pain and blockage in the urinary tract.

Active Surveillance: This is similar to the watchful waiting approach, the only difference is that the patients will have scans, and biopsies once or twice a year to monitor the growth of cancer. This approach is used when you don’t have any symptoms of prostate cancer and the cancer is growing very slowly.

Radiation Therapy: This treatment option includes the use of radiation to kill and destroy the cancer cells present in the prostate. This method is proven to be one of the most effective treatments for advanced and localized cancer. There are different types of radiation therapy such as External Beam Radiation Therapy (EBRT) and Brachytherapy.

Hormone Therapy: the surgeons mostly used the hormone therapy in combination with the radiation therapy. Hormone therapy is used to control cancerous cell growth. It includes stopping your body from producing testosterone hormone by injections, medicines (tablets), or sometimes a combination of both. Sometimes, the testis are surgically removed from the body as testis are where the testosterone is produced.

Chemotherapy: This treatment option is used when the prostate cancer has spread to other parts/organs of the body, also known as metastatic prostate cancer). The chemotherapy involves use of medicines that will destroy the cancer cells. Sometimes chemotherapy and hormone therapy are used in combination. Your doctor may use a taxane chemotherapy or a platinum chemotherapy.

Immunotherapy: One approach to treat cancer is to re-train the immune cells of our body’s immune system to respond to abnormal functioning of the cancer cells. By this, our body’s immune system will kill the infected and cancer cells that are harming the body. The immunotherapy includes sipuleucel-T immunotherapy and Pembrolizumab.

Targeted Therapy: This therapy is used to treat recurrent and advanced prostate cancer when the hormone therapy is not showing any results. Targeted therapy involves using medicines that identify the mutations (genetic component) of the cancer cells and tumors and destroy them.

Focal Therapy: This is a new approach to treating prostate cancer which destroys the tumor that has formed in the prostate gland. The focal therapy includes:

  • High-Intensity Focused Ultrasound (HIFU), which uses soundwaves that generate heat to destroy the cancer cells in the prostate gland.
  • Cryotherapy, which uses cold gas to freeze the cancer cells in the prostate gland and remove the tumor.
  • Laser ablation, which uses high heat to destroy the cancer cells in the prostate gland and remove the tumor.
  • Photodynamic therapy, which uses light wavelengths to destroy the cancer cells in the prostate gland and remove the tumor.

Surgery: The surgery is done to remove the prostate gland from the body. It is known as prostatectomy. The different types of prostatectomy surgery are listed below.

  • Radical Prostatectomy: When the surgery is done to remove an entire prostate gland, it is known as radical prostatectomy. In this procedure, along with the prostate gland, the lymph nodes and the surrounding tissues are also removed. It is a recommended procedure for patients who have prostate cancer with a high risk of metastasis.
  • Simple Prostatectomy: In this procedure, only the inner portion of a prostate gland is removed, and the outer portion is kept.

The prostatectomy surgery can be done by using different techniques such as: -

Laser Prostatectomy: It is a method used for enlarged prostate treatment. In this method, the surgeon inserts a scope from the urethra and a laser light is passed through the scope which targets the tumor and shrinks it. After that, the tumor tissue is removed.

Laparoscopic Prostatectomy: It is a procedure that involves making small incisions on the lower abdomen and inserting a laparoscope from one incision and surgical tools from other incisions and the surgeon performing the surgery by looking at a TV monitor. A laparoscope has a tiny camera and a light that shows the live video on a TV screen as the surgeon performs the surgery.

Robotic Prostatectomy: It is the most widely used advanced technique to perform prostatectomy in which the surgeon uses a robotic arm to perform the surgery. In this procedure, the surgeon sits on a console that has a remote control. The surgeon controls the robotic arms while sitting at a little distance from the patient by looking at a 3D and magnified view of the internal organs. This approach is very beneficial as it makes an even smaller incision and performs the surgery with great precision.

Open Prostatectomy: In this procedure, the surgeon first inserts a Foley Catheter from the tip of the penis through the urethra into the urinary bladder to drain out the urine. Then, your surgeon will make one large incision on the lower abdomen or right above the pelvic bone and perform the surgery. Your surgeon will then disconnect the prostate gland from the blood vessels and surrounding tissues and then either remove the entire prostate gland or only the problematic parts. The incision site will be then closed with the stitches.

Recovery After Prostatectomy

After the surgery is over, you will be taken to the recovery room and monitored until the anesthesia wears off and you wake up. When you wake up, you will find that you will have some tubes and drains, these include a drip that is attached to give you fluids and medicines such as patient-controlled analgesia (PCA) through the vein in your arm, a drain that drains any fluid or blood released at the surgical site, a urinary catheter to drain the urine, and an oxygen mask.

You might feel drowsy due to the effect of anesthesia. You will need to spend about 1 to 2 days in the hospital. You might have some temporary symptoms like constipation, erectile dysfunction, etc. However, these are temporary and will be cured as you heal. The total recovery period after prostate cancer surgery may take about 4 to 6 weeks.

For the management of pain and discomfort, your doctor will prescribe pain medications to you. In most cases, the surgeon uses dissolvable stitches (to close the incision) that dissolve into the body over time. If the non-dissolvable stitches are used, you will be given a follow-up appointment usually after 7 to 10 days to remove the stitches.

When you are discharged from the hospital, your surgeon will give you some instructions to follow which include decreasing the sitting time, taking frequent walks around the house or outside, etc. You can return to work and regular activities within a month, with proper rest and healthy lifestyle habits.

Cost of Prostate Cancer Treatment in India

The total cost of the treatment of prostate cancer is influenced by many different factors such as the stage and severity of cancer, type of treatment planned, pre and post-treatment consultation, medication cost, travel cost, oncologist’s fees, hospital fees, overall health of the patient, diagnostic test cost, insurance coverage, etc. Considering these factors, the treatment for prostate cancer in India may cost you around 4,807 USD to 7,211 USD.

  • High-Intensity Focused Ultrasound (HIFU) for prostate cancer in India: 8,000 USD
  • Cyber-Knife Radiosurgery for prostate cancer in India: 6,700 USD
  • Open Prostatectomy Surgery in India: 5,500 USD
  • Laparoscopic Prostatectomy Surgery in India: 7,500 USD
  • Robotic Prostatectomy Surgery in India: 7,500 USD
  • Radiation Therapy for prostate cancer in India: 1,644 USD
  • Chemotherapy for prostate cancer in India: 1,802 USD
  • Cryotherapy for prostate cancer in India: 50 USD

The treatment for prostate cancer is far more affordable in India as compared to many developed countries. For a better understanding, let’s compare the cost of treatment for prostate cancer in India with the developed countries; like the USA and the UK.

Treatment for Prostate Cancer Cost in India Cost in USA Cost in UK
Cyber-Knife Radiosurgery $6,700 $30,000 $24,500
HIFU (High-Intensity Focused Ultrasound) $8,000 $35,000 $28,000
Laparoscopic Prostatectomy $7,500 $28,000 $23,000
Robotic Prostatectomy $7,500 $35,000 $28,000
Open Prostatectomy $5,000 $25,000 $21,000

It is evident from the cost compared above that the cost of treatment of prostate cancer is too low and affordable in India than in other countries. Although India is a developing country, the medical staff and the hospitals in India provide top-notch medical treatment with the highest success rate and successful medical procedures. Under the treatment cost of prostate cancer in the USA and UK, you can cover the total cost including the travel, stay, medicine, and treatment costs in India. Hence, the treatment for prostate cancer in India is much more affordable and profitable for international patients.

Conclusion

Prostate cancer is common in men especially the men of African origin. With an increase in the prostate cancer cases every year, the proper diagnosis and treatment options are insufficient in many low-middle income countries due to which many people especially from Africa travel to India for treatment due to low cost and supreme medical service in Indian cancer hospitals. The oncologists in Indian hospitals are globally trained and have undergone training in international institutes. The Indian hospitals bring in new innovative treatment approaches and technology in order to provide sufficient and optimal treatment options. Due to this reason, a lot of African men trust Indian Cancer Hospitals and visit India for their enlarged prostate treatment.

Prostate Cancer Treatment FAQs

Is prostate cancer a curable disease?

Yes, we can cure prostate cancer. Nowadays, many treatment methods and techniques are available to treat and completely cure prostate cancer such as radiation therapy, medications, surgery, etc. So, there is no need to be stressed if you are diagnosed with prostate cancer. With the expertise of your oncologist and a wide variety of treatment options available, you can treat prostate cancer.

Is prostate cancer a common type of cancer?

Yes, prostate cancer is the 4th most diagnosed cancer in the world. It is most common In African men. There is one new case of prostate cancer diagnosed every 2 minutes and prostate cancer death every 15 minutes.

How much is prostate cancer treatable?

Most of the prostate cancers that are diagnosed in the early stage are highly treatable so the success rate of the treatment is high. However, the advanced stage of cancer may lead to death, so it is important to get an early diagnosis and the treatment should be initiated as soon as diagnosis of prostate cancer is made. Early detection and treatment are beneficial for maintaining a healthy body and reducing the complications that the body has to go through.

Can we prevent prostate cancer?

Yes, maintaining a healthy lifestyle can not only prevent prostate cancer, but it also prevents other types of cancer and many other diseases. Healthy eating habits, regular exercising, avoiding smoking and alcohol as much as possible, avoiding megavitamin supplements, proper sleep, etc. are a few points that help you maintain a healthy body.

What is a Gleason score for prostate cancer?

A Gleason score is a grading system that shows how severe (advanced) your prostate cancer is and whether it has spread to other parts of the body or not. If you have a low Gleason score that means that your prostate cancer is small and growing very slowly, but if it is high that means that your prostate cancer is growing fast and may have spread to other tissues.

Is prostate cancer a hereditary disease?

Not all cases of prostate cancer are hereditary. However, if you have a family history of prostate cancer and most of your 1st-degree relatives such as your parents, siblings, etc. have prostate cancer, then you might have a genetic risk factor for developing prostate cancer. You should consider having a genetic consultation to see if you have any genetic risk factors that can develop prostate cancer.

Can I have prostate cancer even if I don’t have any symptoms?

Yes. Suppose you don’t have any symptoms but still want to make sure about whether you have prostate cancer or a high risk of developing prostate cancer. In that case, you can determine it by the two tests which are the Prostate Specific Antigen test commonly known as the PSA test and another one is Digital Rectal Exam commonly known as the DRE test. It is recommended to have these tests once every year especially if you are of African origin or if you are 50 + years of age.

Are there any medical conditions other than cancer that affect the prostate gland?

Yes, with an increase in age, many men experience certain medical conditions related to the prostate such as an enlarged prostate, prostatitis, etc. These diseases cause enlargement of the prostate gland due to infection and inflammation. It also causes blockage in the urethra or a urinary bladder and you will have difficulty in passing urine.

Can I live a normal life after Prostatectomy Surgery?

Yes, the prostate is a small gland that releases a seminal fluid that helps in sperm transportation. The surgery either removes an entire or a part of a prostate gland. In certain cases, you may experience infertility, however, removing the prostate does not cause any harmful effects in the body.

Will a prostate gland tumor grow back?

Sometimes in about 20 to 25% of patients, prostate cancer reoccurs. However, if you are maintaining a healthy lifestyle and if you had a radical prostatectomy surgery, prostate cancer does not occur as most oncologists use a combination of treatments to treat prostate cancer.

Does prostatectomy surgery reduce my life expectancy?

No. Removing a prostate may sometimes cause infertility but it does not affect how much you live. In fact, many healthy men have extended their life expectancy after prostatectomy surgery.

What are the organs that prostate cancer can spread to?

In the majority of prostate cancer cases, the cancer starts in the prostate gland and if it reaches metastasis, it can spread to other organs of the body such as bones, lymph nodes, lungs, liver, etc. In very rare cases, the cancer starts in other organs of the body and then spreads to prostate cancer.