Highly Advanced Prostate Cancer Treatment at MyMedOpinion Affiliated Top Cancer Hospitals in India | Low Cost Prostate Cancer Treatment in India

Treatment for Advanced Prostate Cancer 

1 ) Minimally Invasive Techniques : 

a) SPAD – super selective intra- prostatic androgen deprivation : In this procedure, a radiopaque dye is injected into the vein of the leg after which an X-ray of the venous network is carried out (venography). Then a medicine that shrinks the blood vessels is injected into the vein (sclerotherapy) resulting in reduction of prostate volume. This provides relief in cases of nocturia, improves bladder emptying and increases urine outflow. There are minimum sideeffects as compared to traditional surgery. 
b) Transurethral microwave thermotherapy (TUMT) : 

• It is a very effective treatment in case of BPH and provides relief from lower urinary tract symptoms after a single procedure. 
• It is a minimally invasive technique performed under local anesthesia. 
• A special microwave urinary catheter is inserted through the urethra into the enlarged prostate. The microwave antennae are then heated up to at least 111 degree Fahrenheit which destroys the surrounding tissues. 
• The procedure takes around 30 minutes to 1 hour after which there is slight swelling and irritation in the prostate. A Foley’s catheter is placed in the bladder to allow bladder emptying without increasing the prostatic irritation and is removed within 3-5 days. 
• There may be a few risks like pain after the procedure, urinary retention and infection but the incidence is very less. 
• The problem of urinary retention resolves within a week’s time, but some patients replace the Foley’s catheter with a temporary prostatic stent to allow volitional emptying of bladder. This improves their quality of life. 
c) Transurethral needle ablation (TUNA) : 

• In this procedure low energy frequency radio energy is delivered through two needles placed inside the prostate by passing through the urethra, creating a high temperature in a small zone, which destroys the excessive prostatic tissue without damaging the urethra. 
• The procedure is performed under local anesthesia on an outpatient basis. It is a single session treatment procedure with the number of needles varying with size of the prostate. 
• It is fairly safe and effective and has minimal side-effects. 

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2 ) Surgical Procedures : 

a) Trans urethral resection of prostate (TURP) : 

• It is the most popular method among patients and doctors for resolving prostate related problems and is considered after medical intervention fails. 
• It involves removing whole or a portion of the prostate gland through the urethra. 
• The procedure is performed under spinal or general anesthesia and involves visualizing the gland using a endoscope. 
• A Resectoscope (which contains an electrical loop to cut the bulging prostate tissue and seal the supplying blood vessels) is introduced inside the penis. 
• The surgery lasts for around 1 and half hours, and cut tissue is carried by fluid into the bladder from where it is washed out. 
• The patient can go home after 3-5 days. Patient is advised to drink lots of fluids and avoid any strenuous activity for a few days (maximum 6 weeks) till the scar heals. 
• He is cured of the symptoms occurring due to urinary pathway obstruction like urinary incontinence, dribbling, nocturia etc. 
• This procedure has very few side effects and a faster recovery period. But sometimes it can cause backward ejaculation of semen (into bladder instead of urethra) during intercourse. This can be managed by certain drugs that keep the mouth of the bladder narrow to reduce backward flow of semen into it. 
b) Radical Prostatectomy : 

• It is the traditional open surgery method used when TURP cannot be performed due to reasons like highly enlarged prostate or bladder injury etc. 
• It is mainly indicated in prostate cancer but can also be done in cases of BPH. 
• The surgery is performed under general anesthesia and an incision is made in the lower abdomen just above the pubic bone (Retropubic approach). At times the incision can be made between the scrotum and the anus depending on the enlargement of the gland or spread of the tumor (Perineal approach). The incision of perineal approach is smaller and has lesser blood loss as compared to retropubic approach and hence has a faster recovery period. 
• On reaching the prostate gland, the gland and extra tissue is scooped out and in case of any injury to surrounding organ like the bladder; a tissue repair is carried out. The urethra is reattached to the bladder and a catheter is left in the bladder to drain out urine. 
• In case prostate cancer is suspected, then surrounding lymph nodes are also removed and sent for biopsy. 
• The patient stays in the hospital for a week and is discharged with the urine catheter in place that has to be kept for 1-3 weeks’ time. 
c) Laser Prostatectomy : is the latest trend in BPH and prostate cancer surgeries because they have lesser blood loss and quicker recovery period. But long term effects of this surgery are yet to be determined. 
There are four Types of Laser Surgeries: 
1. Green Light PVP Laser : This procedure uses green light to vaporize the prostate and useful for majority of patients with enlarged prostate. A tube with light and lens called the cystoscope is inserted into the penis. The laser beam is introduced through the cystoscope and directed towards the prostate. It creates high energy which vaporizes the excess tissue and relieves the urethral blockage. The procedure is done in a short time and the patient can go home the same day and resume daily non strenuous activities within a couple of days.
2. Holmium Laser : This is the most commonly used technique and is performed under general anaesthesia. The laser of 2140nm wavelength and 0.4mm penetration is introduced through the cystoscope that is inserted into the penis at the start of the procedure. The laser cuts and vaporises the enlarged prostate tissue and relieves urinary blockage. Some tissue pieces are directed to the bladder from where they are flushed out. The procedure is done in a short time and the patient can go home the same day or the next day and resume daily non strenuous activities within a couple of days. The procedure is relatively bloodless. 
3. VLAP : This procedure has many disadvantages and has become virtually obsolete with the coming of Holmium Laser. The technique uses neodymium:yttrium-aluminum-garnet (Nd:YAG) laser which has a wavelength of 1064nm. The laser beam is directed towards the prostate gland via the cystscope. The beam generates a lot of heat which coagulates the gland tissue. The surgery is performed under regional or general anaesthesia. The technique was not popular among patients as the coagulated portion caused irritation. Also the urine catheter had to be kept for long. Soon this was replaced by Holmium Laser. 
4. ILC : Interstitial Laser coagulation therapy was used to coagulate tumours which could not be cut and removed especially in the brain, neck, liver, pancreas etc. in this procedure the laser probe is in direct contact with the prostatic tissue and generates temperature of 60 degrees Celsius which destroys the cell protein. The destroyed cells are absorbed in due course of time and a shrunken prostate gland remains. The urethra is not affected. The procedure is performed under general or regional anaesthesia. The rigid laser probe is inserted through the cystoscope and pushed till it enters the prostate after which it is activated to produce the heat. The effect is localised to the prostate tissue only. 

d) Robotic Prostatectomy : This procedure is carried out using the computer and is an advanced form of minimally invasive surgery. In this technique, small incisions are made in the lower part of the abdomen and the entire surgery is carried out using Tele-manipulator. The surgeon performs actions, which moves the Tele-manipulator which in turn is connected to the robot’s arms which replicate the surgeons hand movements and perform the surgery. The surgery is controlled remotely but involves great precision because of which it is soon becoming very popular. The procedure has resulted in favourable outcome as there is less blood loss, faster recovery and shorter hospital stay. 
Surgeons also perform laparoscopic robot assisted surgeries using the Da Vinci system which uses miniature surgical tools to carry out the surgery through the keyhole incisions. This method is gradually gaining popularity in treatment of prostatic cancers as there is great precision involved while removing the prostate gland without affecting the other tissues. 

Robotic laparoscopy prostatectomy Cost in India - Prostate Treatment Hospital India

Robotic laparoscopy prostatectomy  in India

Robotic laparoscopyprostatectomy offers several advantages. Although experts do not agree as to whether robotic or open surgery is best, the majority of prostate cancer surgeries  are being done with the laparoscopic/robotic approach, particularly at high volume medical centers that specialize in prostate cancer treatment. The post-operative goals for treating prostate cancer are the same regardless of whether the operation is done with an open or laparoscopic approach.

Less Scaring

The first advantage to robotic surgery is that it is an application of advance technology and is minimally invasive. Instead of having a 5 or 6” incision to the skin and abdominal fascia (See image below, left), patients have a series of small “band-aid” incisions. (On right) 

A Shorter Hospital Stay

With smaller incisions, the postoperative pain is significantly less, which means your length of hospitalization is shorter - as is the time to return to usual activity.

After the laparoscopic/robotic prostatectomy patients typically do not require an inpatient hospital stay over one night. Surgery is done in the morning and they typically go home after lunch on the first operative day.

Comparatively, after the open prostatectomy patients spend at least two nights in the hospital primarily for pain control, nausea and difficulty getting out of bed and getting back to an activity level that would be appropriate for them to be discharged home.

Less Drugs, More Blood

Patients' need for postoperative pain medicine and narcotics is also greatly reduced after the laparoscopic/robotic approach compared to open surgery.

Another advantage to robotic surgery is decreased intraoperative blood loss. During traditional open surgery, it is not at all uncommon for patients to lose between 600 cc and 1000 cc of blood intraoperatively given the intense vascularity of the prostate and its surrounding tissues. This entails some significant risk of intraoperative or postoperative transfusion (and secondarily the attendant risk of transfusion) among these patients.

During robotic/laparoscopic prostatectomy, blood loss is usually 200 cc or less, which is very minimal and has a negligible risk of needing a transfusion. This is likely a minor difference as the transfusions are quite safe. However, the small difference among treatment approaches may be quite important to some patients.

Postoperative Catheterization

The third advantage of robotic surgery over open surgery is a reduction in the required postoperative catheterization time. After open surgery, foley catheters are left to drain the urine for usually two or more weeks. After the robotic approach, the catheter typically remains in place 5 to 7 days. The reason for this difference is unclear but may be related to the increased precision and visibility the robotic approach offers and also maybe that a running anastamosis (bringing the bladder neck and urethral sphincter back together) may be done in a water-tight fashion compared to the open approach.

Erectile Function

The fourth advantage of robotic prostatectomy is the (at least theoretical) improved ability to preserve the erectile nerves. During an open prostatectomy through an incision on the anterior abdominal wall, the nerves that provide erection are hidden behind the prostate. The approach taken using the surgical robot, enters the abdomen and the robotic arms are positioned posterior to the prostate with the nerves directly in front of the robotic/laparoscopic camera. In this way, the nerves maybe preserved, primarily because the anatomy can be seen more clearly compared to open surgery.

In addition, the decreased blood loss of the robotic approach improves the intra-operative visibility. As you can imagine, attempting to preserve delicate nerve structures can be quite challenging in the pool of blood versus in a relatively dry surgical field that is expected with the laparoscopic/robotic approach.

Robotic Prostate Surgery 

 Usually in conventional approach, surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave cancer behind. In the Advanced Robotic Technique (ART) surgeons uses a sophisticated mastr slave robot that incorporates 3-D high definition vision, scaling of movement and wristed instrumentation that gives him the ability to perform Prostate excision with minimal risk of leaving the cancer behind and also minimal bleeding and post operative risk of incontinence and impotence.

Neither clinical nor imaging tests are sensitive enough to capture a tumour at T3 stage where it has become locally advanced and a risk for spreading to other body parts. Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence Da vinci robot system minimizes side effects thereby greater control for the patient over urinary discharge i.e. continence and return to normal sexual function after the surgery.

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Laser Prostate Surgery Hospital in India - TURP

Minimally Invasive Laser Prostate Surgery in India

What is Transurethral Resection of Prostate ?

Transurethral Resection of Prostate or T.U.R.-Prostate or T.U.R.P. is a treatment of choice if the enlarged prostate gland compresses on the urethra resulting in obstruction of urinary outflow. In the TURP, the glandular tissue is removed in small chips or pieces as opposed to Radical Prostatectomy where the prostate gland is removed in it's entirety. T.U.R.P. is an endoscopic procedure where the prostate gland can be visualized while it is being resected.

Prostatic surgery or Prostatectomy comprises other form of surgery such as Suprapubic prostatectomy, Transurethral resection of the prostate(TURP), Open prostatectomy, Laser prostatectomy, Transurethral needle ablation,(TUNA). On the basis of the size of the prostate gland, different kind of prostatic procedures are decided. TURP is performed on the glands bigger than 30 grams and less than 80 grams. But if the prostate gland is bigger than 90 grams, open prostatectomy is performed. Prostatic surgery is not performed on the patients having bood clotting disorder or bladder disease (neurogenic bladder).

• Irregular or absent periods

• Hormone imbalance

• Smoking or alcohol use

• Endometriosis

• Fibroids

• History of infertility

Minimally Invasive Laser Prostate (TURP) Surgery in India

Laser Prostatectomy

Laser prostatectomy or Laser for prostatic surgery is recently developed minimally invasive treatment modalities for patients having BPH i.e benign prostatic hyperplasia or benign prostatic hypertrophy. The term Benign prostatic hyperplasia or benign prostatic hypertrophy means increase in size of the prostate gland in the men above 50 years of age. Laser Prostatectomy is used mainly to remove the prostate gland when there is no cancer in it but its size enlarges due to which it creates problem in the urinary tract. Laser prostatectomy is a short and easy procedure, usually after which the patient can return to their home on the day of operation itself.

• Procedure for laser prostatic Surgery

Patients who has a history of BPH are recommended by their doctors to undergo laser prostatic surgery as because they cannot be treated by the medical therapy. Before the surgery the patients has to undergo several preoperative measurements like American Urologic Association symptom score, Uroflowmetry, Prostate-specific antigen and Transrectalultrasonography (TRUS). Laser prostatectomy uses beams of light to destroy prostate tissue. It is mainly done under the use of regional anesthesia. This laser beam helps in destroying any prostate tissue which blocks the opening of the urethra and bladder outlet. After the laser prostatic surgery, the rate of urine flow improves and reduces the symptoms of BPH. A Foley catheter may be placed in the patient body after the surgery to help in emptying the bladder. For few days after the surgery catheter usually remains in place.

Types of Minimally Invasive Laser Prostate (TURP) Surgery in India

Greenlight Laser Treatment For Benign Prostatic Hyperplasia

The GreenLight Laser treatment therapy is the most effective, novel and advanced technique for the treatment of an enlarged prostate, which is clinically referred to as Benign Prostratic Hyperplasia (BPH).The treatment involves a laser beam therapy which evaporates the enlarged prostatic tissue that presses on the outlet of the urinary bladder causing urinary outflow obstruction symptoms. The procedure involves the use of a high powered system (80-120 watts), which generates laser beams, which vaporizes the extra prostatic tissue. This is unlike other procedures like Transurethral Resection of the Prostate (TURP), which use electrical current to burn the tissue, and also puts the surrounding structures at risk of being burnt and destroyed.

The procedure is also referred to as Laser Ablation of the prostate or Photo-selective vaporization of the prostate (PVP) or photo vaporization of the prostate. This procedure has a greater efficacy (compared to other laser treatments like interstitial laser therapy-Indigo and Holmium laser therapy-Lumenis) with fewer side- effects, complications and risks.

Conventional vs Laser Prostatectomy / TURP:

The Laser TURP procedure is much more advanced & beneficial than the conventional procedure. The differences in the two are:

• For the conventional TURP, the resectoscope, a combined visual and surgical instrument is used, whereas the Laser procedure involves use of advanced laser energy to cut excess gland, thus there is no loss of blood & shorter hospitalization is required

• Blood thinning agents have to be stopped a week to 10 days before the procedure for conventional TURP, which puts the heart at risk, whereas the laser TURP is done with the blood thinning agents on board, which is highly beneficial for cardiac patients.

• Conventional TURP allows tissue removal at only 1gram/min, whereas laser can vaporize tissue as fast as 3-4 grams/ min.

• For prostates larger than 100gm, open surgery is required in case of conventional TURP, whereas lasers can effectively perform surgery in such large prostate cases

Advantages of Laser TURP:

1. Safer & Faster

2. No blood loss

3. Shorter hospital stay & faster recovery

4. Highly beneficial for

o Patients on blood thinning agents like heparin, aspirin, clopidegrol etc.

o Patients with kidney dysfunction

o Patients whose prostate gland size more than 60 gm

o Patients whose prostate gland size more than 60 gm

o Patients who are at poor risk for anesthesia

o Patients with cardiac complications or who have undergone joint replacement surgery

Laser TURP in India

People from different parts of the world, especially countries like Nigeria, Kenya, Ethiopia, Uganda, Tanzania, and Western countries, come down to India to consult with reputed urologists. Our hospitals are staffed with physicians trained in reputed medical universities abroad, and are equipped with the most modern diagnostic and surgical equipment.

We are associated with some of the best urologists in the country who can perform Laser TURP at state-of-the-art hospitals using advanced Diode lasers. Another advantage of getting the procedure done in India is the cost aspect. Laser TURP in India will cost only a fraction of what you would have to pay elsewhere.