Common Specialities
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Overview

what is Prostate Cancer?

The prostate is a gland of the male reproductive system, located directly under your bladder. This gland consist of tiny other glands that produce a fluid which is a part of the semen. Prostate cancer begins when the cells present in the prostate gland start to grow uncontrollably. The cancer starts with tiny changes in the shape and size of the prostate gland cells- known as Prostatic intraepithelial neoplasia (PIN).

Prostate cancer is a very slow progressing disease. In most cases, patients do not realise that they are suffering from this condition. When the cancerous tissues start spreading or there is a serious life risk, one may need to undergo a prostate cancer surgery. There are various types of surgery that can be performed for treatment such as radical retropubic prostatectomy, radical perineal prostatectomy or modern laparoscopic techniques.

Indication

A patient may require a prostate cancer surgery in the following conditions:

  • The age, general health and stage of cancer determine whether a patient would need surgery or not
  • For removing the cancerous tissues
  • Treating localized prostate cancer, which involves removing the entire prostate and the surrounding tissues, including lymph nodes if necessary
  • If the cancer has reached the outer layer of the prostate and is spreading in the seminal vesicles
  • When the cancer is spreading to the other parts of the body. It could be to the nearby lymph nodes, and other organs like rectum, bladder or the pelvis.

Pre Procedure

Before surgery, you may have to undergo a cystoscopy so that the doctor can examine your prostate size and urinary system. Other tests for measuring your prostate and urine flow will also need to be conducted. Apart from this, there are certain instructions that need to be followed:

  • Inform your doctor of all the medications that you are take and see if you need to stop taking any of them before the surgery. For example, you may be advised to stop medicines that can increase the risk of bleeding during the surgery.
  • You may have to stop drinking and eating anything from the midnight on the day of your surgery. In case you need to take any medication, make sure you have it with very little sips of water.
  • An enema may be required to be done prior to the surgery. Enema is a procedure for cleansing the bowel before a medical examination or surgery.

During Procedure

A prostate cancer surgery can be done in two ways. The main type is known as radical prostatectomy. There are further two ways to perform this operation. One is radical retropubic prostatectomy, where the surgeon makes a cut in the lower abdomen. You will be administered general or epidural anaesthesia. The prostate gland and the nearby tissues will then be removed. In case there is a possibility that the cancer has spread to the lymph nodes nearby, the surgeon may remove them too during the surgery.

The second type is the radical perineal prostatectomy, where the incision is made in the skin between your anus and scrotum. The lymph nodes cannot be removed in this case. This surgery requires less time, causes less pain and has a faster recovery period. However, there are possibilities of erection problems in patients undergoing this surgery.

There are laparoscopic approaches too for conducting a prostate cancer surgery where much smaller incisions and long surgical tools are used for removing the prostate.

Post Procedure

After the surgery has been performed, a catheter is placed in the penis so that the bladder can be drained. You need to keep the catheter for 1-2 weeks. Depending on your condition, the doctors will decide if you can be discharged in a day or if you need to spend a few more days in the hospital. You will be instructed on handling the catheter and caring for the surgical site before you go home.

The incision site can be sore for a few days. There may be other problems like blood in the urine, urinary irritation, difficulty in holding urine, urinary tract infection (UTI) and inflammation of the prostate. These symptoms are normal and will be there for a few weeks post-surgery. It is advised to decrease your activity levels for the time being, including sex.

Risk & Complication

A complication in the course of a surgery may depend on your age, overall health condition and the efficiency of your doctors. Like every other surgery, a prostate cancer surgery can have some risks and complications such as:

  • A reaction to the anaesthesia that had been administered during the surgery
  • Bleeding due to the surgery performed
  • Blood clots in the lungs or the legs
  • Damage to the nearby organs
  • An infection at the site of the surgery
  • In very rare cases, a part of your intestine may be affected or injured during the surgical process, leading to infections in the abdomen. Another surgery may be required to correct it.
  • In case the lymph nodes are removed during the surgery, there can be a formation of lymph fluids that would need to be drained

More Info

As a surgery for prostate cancer is a major surgery, it is important that you give your body some time to recover. Take adequate rest while recuperating at home, and refrain from lifting any heavy objects for a few weeks. It is also recommended to avoid driving in the first few days. It can take about 6-7 weeks to feel normal again. Make sure that you take your medicines in time and follow the instructions of your doctor, including any lifestyle changes that you need to make.

The cost of a prostate cancer surgery could be approximately Rs. 3,14,972 - Rs. 4,50,000.

Popular Health Tips

Common Symptoms Of Prostate Cancer!

MCh - Urology, MBBS
Urologist, Chennai
Common Symptoms Of Prostate Cancer!

The prostate gland is a small walnut-shaped organ that produces seminal fluid which carries the sperm and also provides them nourishment.

Prostate cancer is one of the most common types of prostate cancer in men. The progress of prostate may take years and so symptoms may not be evident until it has reached an advanced stage. Also, prostate enlargement is an extremely common condition in most elderly men. This condition is known as benign prostatic hypertrophy (BPH). The symptoms produced by prostate enlargement are similar to those of prostate cancer in the earlier stages. Therefore, men may confuse the cancer symptoms with BPH symptoms and often ignore the same. For most men, BPH is part of ageing and night-time visits to the bathroom are quite common.

Symptoms of prostate cancer can be clubbed into two broad categories – urinary and others.
Urinary symptoms are due to the enlarged prostate gland pressing on the urethra, the tube that carries urine from the bladder to the outside. These include:

  1. Burning sensation with urination
  2. Painful urination
  3. Difficulty in starting and stopping a urine stream
  4. Dribbling in between a stream
  5. Inability to control a stream, often causing urine to leak before reaching the toilet
  6. Increased urgency to urinate, especially at night
  7. A reduced flow of urine
  8. Lack of control over bladder
  9. Presence of blood in the urine, often giving it a pinkish hue

Non-urinary symptoms include:

In addition, there would also be generalized symptoms of cancer, including:

  1. Generalized lethargy and weakness
  2. Anemia
  3. Uncontrolled weight loss
  4. Lack of appetite
  5. Back pain

As noted above, these symptoms are not indicative of prostate cancer. Even prostate infection or in older men prostate enlargement can cause these symptoms. Therefore, it is essential to correlate these symptoms with risk factors and clinical diagnosis.

Risk factors include age, family history, poor diet choices, higher testosterone levels, prostatic neoplasia, and presence of BRCA1 or BRCA2 genes.

Clinically, when a patient experience any of the above symptoms, the doctor would need to confirm the diagnosis via:

  • Digital rectal examination, which will confirm that the prostate is enlarged indeed
  • Chemical tests to check for prostate-specific antigen (PSA) which is often increased with any disease of the prostate
  • A biopsy to identify the presence of cancerous cells

A combination of clinical presentation, lab, and imaging will help in confirming the diagnosis. Earlier the diagnosis, better is the prognosis.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3579 people found this helpful

Prostate Cancer - What Is Bone Directed Therapy?

MBBS, DM - Oncology, MD - General Medicine
Oncologist, Nashik
Prostate Cancer - What Is Bone Directed Therapy?

If prostate cancer spreads to other parts of the body, it targets and goes to the bones first. And, if the cancer has spread outside the prostate, preventing or slowing its spread to the bones is a major goal of treatment.
If the cancer has already spread to the bones, relieving pain and other complications is also a very important part of the cancer treatment. There are a number of ways and means to prevent and treat prostate cancer’s spread to bones.

Understanding them in detail

Bone metastasis or spread of cancer to the bone is an extremely painful condition. This can also cause fractures or potentially fatal conditions like high blood calcium levels. Bone-targeted treatments such as hormone therapy, chemotherapy, and vaccines are used but so are a slew of other treatments more specifically targeting bone metastasis and its side effects. These are:

1. Bisphosphonates: Bisphosphonates are drugs that work by slowing down the reproduction of bone cells or osteoclasts. These cells work by breaking down the hard mineral structure of bones to keep them healthy. These bone cells often become overactive when prostate cancer spreads to the bones.

Bisphosphonates can also be used:

  • To help control and relieve bone pain
  • To control the high calcium levels caused by prostate cancer metastasizing to bones
  • To help slow the growth of cancer
  • To help delay or prevent fractures
  • To help strengthen bones in men on hormone therapy

Zoledronic acid or Zometa is the most commonly used bisphosphonate for prostate cancer. This is given as an intravenous (IV) injection, usually once every 3 or 4 weeks. The patients on this drug are also advised to take supplements containing calcium and vitamin D to prevent low blood calcium levels. Side effects include flu-like symptoms and bone or joint pain as well as kidney problems and sometimes osteonecrosis of the jaw (ONJ). In ONJ, part of the jaw bone loses its blood supply and dies, leading to tooth loss and infections of the jaw bone.

2. Denosumab: This is another drug that can help when prostate cancer spreads to bones. Like the bisphosphonates, denosumab also works by blocking osteoclasts. This drug is used:

  • To help prevent or delay fractures
  • To help slow the spread of cancer to the bones despite hormone therapy
  • This drug is injected intravenously every 4 weeks.
  • Common side effects include diarrhea, nausea, and fatigue.

3. Corticosteroids: These lower bone pain in some men in whom cancer has spread to the bones.
4. External radiation therapy: This helps if the pain is limited to one or only a few areas of bone. Radiation can also be aimed at tumors on the spine and other parts of the body.
5. Radiopharmaceuticals: These are drugs that contain radioactive elements and these are injected into a vein and go and settle in areas of damaged bones, where they give off radiation that kills cancer cells. The major side effects of these drugs is a decrease in blood cell counts which makes the body of the patient more prone to infections and bleeding.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3439 people found this helpful

Prostate Cancer - What To Expect

MBBS, MS - General Surgery, MCh - Urology
Urologist, Lucknow
Prostate Cancer - What To Expect

Cancer is the most dangerous disease noticeable throughout the world. The most common type of cancer that affects men is prostate cancer. Prostate is a small exocrine gland situated directly below the bladder and in front of the rectum. This is gland is approximately in size of a walnut and plays an important role in production of a milky fluid during orgasm of sex in which the semen travels. During the climax stage of the prostate gland is forced to push the fluid and remove the semen out of the reproductive structures.

Prostate gland is a slow progressive disease which makes many males left unidentified even the presence of prostate cancer even until they die. 6 out of 100 male over the age of 60 are getting prostate cancer. Though prostate cancer can be cured at a better rate when compared to other type of cancer it is always best to stay protected. Prevention is always better than cure. Here are few tips to keep your prostate healthy.

Signs and symptoms of prostate cancer-

During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:

  1. The patient urinates more often

  2. The patient gets up at night more often to urinate

  3. He may find it hard to start urinating

  4. He may find it hard to keep urinating once he has started

  5. There may be blood in the urine

  6. Urination might be painful

  7. Ejaculation may be painful (less common)

  8. Achieving or maintaining an erection may be difficult (less common).

If the prostate cancer is advanced the following symptoms are also possible:

  1. Bone pain, often in the spine (vertebrae), pelvis, or ribs

  2. The proximal part of the femur can be painful

  3. Leg weakness

  4. Urinary incontinence

  5. Fecal incontinence

Ways to have a healthy prostate –

  1. Diet and weight – the most important factor is the diet to maintain a healthy weight. Avoid fatty food items and take fats from vegetables than from animals. Avoid dairy products and increase the intake of fresh fruits and vegetables.

  2. Exercise – have a regular practise of doing exercise at least for 30mins a day. This really helps you to keep your body fit.

  3. Be precautious – if you have a family history of prostate cancer or if you feel you are at high risk of getting prostate cancer talk with your doctor about it and take preventive drugs as per the doctor’s advice.

  4. Red foods – research shows that men who consume red foods like watermelon, tomato and other red fruits are at lower risk of getting prostate cancer as they contain a powerful antioxidant called lycopene

  5. Caffeine – three to four cups of coffee per day reduces your risk of getting prostate cancer.

  6. Stop smoking – if you are at high risk of getting prostate cancer it is best advised to quit smoking and alcohol.

In case you have a concern or query you can always consult an expert & get answers to your questions!

1870 people found this helpful

Prostate Cancer - How Bone Directed Therapy Can Help?

M.Ch, Memorial Sloan Kettering Cancer Center, New York, USA, Baroda Medical College, Gujarat Cancer & Research Institute
Oncologist, Ahmedabad
Prostate Cancer - How Bone Directed Therapy Can Help?

Prostate cancer is a condition triggered by the abnormal and uncontrolled growth and division of some cells of the prostate gland. Today, incidences of prostate cancer are alarmingly rising in India. In fact, some reports suggest that the cases of prostate cancer are likely to double by the year 2020, all the more reasons to manage and control the condition on time.

Like the other forms of cancer, prostate cancer can also metastasize and affect the other vital organs of the body (Secondary Cancer). One of the body parts where the prostate cancer is most likely to metastasize first are the bones. As per the American Cancer Society, bone metastasis can give rise to a host of complications and discomfort including Hypercalcemia (elevated levels of blood calcium levels). There will also be severe bone damage with frequent bone fractures which can be quite painful. Thus, it is essential that the spread of prostate cancer is somehow controlled or slowed down. In this regard, the Bone Directed therapy deserves a special mention.

The Osteoclasts are cells in the bone that plays a pivotal role in bone reabsorption, ensuring that the bones stay healthy and disease free. The metastasis of the prostate cancer to bones results in the osteoclasts becoming over-reactive. This, in turn, can result in a myriad of problems affecting the bones. The Prostate Bone Directed Therapy involves the use of drugs and medications that will help to regulate and slow down the over-reactive osteoclast cells. For this purpose, the drug that is commonly used is Zometa or Zoledronic acid, which is a type of Bisphosphonate.

The use of this drug can go a long way to ensure that the bones remain healthy by

  • Lowering the level of the calcium in the blood.
  • It also contributes significantly preventing the bone loss, bone thinning, and bone metastasis.
  • As per various scientific studies, the use of Bisphosphonates can work wonders to slow down or arrest the metastasis of prostate cancer to the bones.


However, if the prostate cancer had already metastasized the bone, the use of the drug Prolia (intravenous injections are often used) may provide fruitful results. The dosage of the drug may vary among individuals depending on the extent of the damage.

  • Prolia is known to play an instrumental role in reducing the incidences of bone breaks and hypercalcemia.
  • In people with a relatively higher level of Prostate-specific antigen or PSA ( a protein produced by the prostate gland cells which can be indicative of prostate cancer), the drug Prolia can help to arrest the growth of the malignant cells.

However, the drug comes with its share of side effects which may range from a sharp dip in the calcium level to allergic reactions, backaches, or even jaw bone complications.
Thus, the drug should be used with great care and under strict medical supervision.

In case you have a concern or query you can always consult an expert & get answers to your questions!

1808 people found this helpful

Prostate Cancer - How Biological Therapy Will Help?

MBBS, MS - General Surgery, DNB - Surgical Oncology
Oncologist, Surat
Prostate Cancer - How Biological Therapy Will Help?

The prostate is a vital organ that located between the penis and the bladder. The prostate is involved in the release of the prostate fluid that keeps the sperm properly nourished. Prostate cancer, as the term indicates, is characterized by the abnormal and uncontrolled growth of cancerous cells in the prostate. Though the incidences of prostate cancer are low in India, necessary precautions and diagnostic steps should be carried out to prevent the condition from jeopardizing our lives.

Prostate screening includes two tests known as the Digital Rectal Exam (DRE) and Prostate-Specific Antigen test (PSA). PSA combined with DRE helps to identify prostate cancer at a very early stage. If any of the tests show an abnormality, a doctor might prescribe an ultrasound such as MRI Fusion or Prostate Biopsy to confirm the diagnosis.

  • Immediate treatment may not be necessary
  • For low-risk prostate cancer, doctors often recommend active surveillance that includes periodic blood tests, rectal exam, and biopsies.
  • Active surveillance helps a doctor to continuously track the growth of cancer cells and the possibility of their spread to other areas of the body.
  • Surveillance is fit for those who are already suffering from a serious condition or for those patients who are above the age of 60.
  • A surgical procedure to remove prostate cancer
  • Surgery is considered when the cancer has metastasized to surrounding tissue and the lymph nodes. There are two kinds of surgeries that a patient can go through- a Robot-Assisted surgery and a Retropubic surgery.
  • Radical Prostatectomy might have risks involved. It is, therefore, wise to discuss the pros and cons of the surgery with the doctor well in advance.

Understanding the treatment options

  • Radiation therapy: Radiation therapy involves the use of high-powered and high-frequency energy beams to kill cancer cells. Radiation therapy is often used to shrink the size of the cancer cells. There could be two types of radiation therapy-Brachytherapy and External beam radiation. Radiation therapy too can have its side effects. Doctors prescribe several medicines during therapy.
  • Hormone therapy: Hormone therapy helps to stop the production of a male hormone known as testosterone. This treatment option includes medication that completely stops the production of testosterone, the medications may also block the flow of testosterone on the cancer cells, and surgery to remove the testicles. Hormone therapy is used in advanced cancer stages.
  • Chemotherapy: Chemotherapy is a drug that goes into the body and kills rapidly growing and metastasizing cancer cells. It is administered through IV (intravenous), or orally as pill or both. This treatment option is employed when cancer spreads to a remote body location and does not respond to hormone therapy.
  • Biological therapy: Biological therapy involves the usage of the body’s immune system to fight cancer. A type of biological therapy known as the sipuleucel-t is used to treat patients with advanced cancer stage and recurring cancer as well. In case you have a concern or query you can always consult an expert & get answers to your questions!
1983 people found this helpful

Popular Questions & Answers

My father age 77 has prostate cancer diagnosed recently.In the month of March his PSA was 9.74 and in May it has risen to 15.94. What does this mean? PL. Suggest whether he should go for any treatment he is slightly apprehensive about the side effects of cancer treatment. Biopsy results show he has adenocarcinoma Gleason scale 4+3=7. As such he has no problem with urine and other things are also normal. Thanks.

MBBS Bachelor of Medicine and Bachelor of Surgery, MS - General Surgery, Genito Urinary Surgery
Urologist, Ludhiana
His prostate cancer more staging investigations like bone scan and MRI of prostate. If is is localised to prostate then he can be watched carefully with regular psa or if he agrees radical prostatectomy. If it has spread to bones then we remove his testis and start on medication which will stop progression of disease. Kindly get these investigations and revert back.
1 person found this helpful

Sir, My prostate color getting change. White darks are going to be done on prostate area. I don't having any pain. Is there any chance of a cancer? Pl advise.

MD, MBBS
Dermatologist, Chennai
No. Fungal infection. Also called jock itch, when occurs in groin. Usually fungal infection is common in moist areas of body like skin folds. It's mostly circular or round in appearance. May be red or black in colour. Treatment depending on the type and severity. Avoid sharing clothes, towels and soap; sweating also increases it. As it has to be differentiated from eczema, bacterial and viral infection, doctor need to see to confirm the diagnosis. So, meet me in my clinic or do direct online consultation by sending photos for detailed information and medicine for treatment.

My father is 77 years old. On 15th. Of November he was operated for prostate which was 34 gms. In his biopsy we came to know about carcinoma of Gleason scale 4+3=7 after a month of waiting we got PSA of 9.372.Please let me know the prognosis of it's spreading to other parts and how much aggressive it can be. Earlier our Doctor suggested a 'Watchful Wait'in his case. I want to know is it alarming? He has diabetes which is controlled by Reclide tablet and for BP he takes Ciladuo (BD). Thanks.

MBBS, M.S. General Surgery, M.R.C.S. England, M.Ch. Surgical Oncology, DNB Surgical Oncology, FEBS Surgical Oncology, DNB General Surgery, MNAMS, FMAS, FIAGES, FAIS, FICS, FEBS Breast Surgery, FACS, Fellowship IFHNOS & MSKCC USA, Fellowship in breast and oncplastic Surgery
Oncologist, Mumbai
I presume he underwent prostate surgery for benign enlargement and cancer was detected incidentally. Hopefully an MRI and bone scan was done for staging to confirm that its a localised disease. We advise watchful waiting or active surveillance for those with localised, early stage and low risk disease or intermediate risk disease in patients with very high comorbidities, reducing the life expectancy of <10 years. Gleason of 7 and PSA below 10 puts him in the intermediate risk hence watchful waiting would have been advised due to comorbidities as the chances of him dying of comorbidities in 10 years is higher than him developing mets of prostate cancer and dying due to the same.

Table of Content

what is Prostate Cancer?

Indication

Pre Procedure

During Procedure

Post Procedure

Risk & Complication

More Info

Play video
Know More About Prostate Cancer
Hello friends, I am Dr Sajjan Rajpurohit. I am a cancer specialist at Rajeev Gandhi Cancer Institute, South Delhi. Today I will talk about the cancer which affects our senior citizens between the age of 50-60 years. It is the cancer in men. Some people most of teh time ignore it as it is a part of normal lifestyle or ageing. But what happens the cancer to begin withn as the symptoms are quite similar to the prostatic hypertrophy. So, I am going to talk about Carcinoma Prostate.

Prostate is an organ which is a male sex organ. It helps in generating fluid which is a composition fo Semen and it also helps in protecting the urine from getting infected. But with an advaced age, there is an increase in the size of prostate and sometimes a growing prostate can turn cancerous.

So, Carcinoma prostate usually manifest as symptoms which are quite similar to Benign Prostatic Hypertrophy (BPH).

So, the symptoms will be;

Frequency of urination
Urgency of urination
Difficulty during the urine passage
Nocturia which means incraesing urination at night, the person has to get up 3-4 times for urine
Blood in urine
Constipation
Pain during urination
These are the earlier signs whereas in the later stages there can be the lower back ache or weight loss. In advanced cases, there can be the involvement of other organs such as liver, lungs whihc can ultimately lead to jaundice, cough, breathlessness.

So, the important thing is to differentiate from the beginning, from the cvery common condition. 1/3rd of the men suffer beyond the age of 60 years, that is, BPH.

It is sometime confused with the very common disease or I can say the physical change in the body which is in the form of Benign Prostatic Hypertrophy. It is very important for your doctor or you to be aware of that these symptoms can be over lapping with the symptoms or with these disease. So, the medicines of BPH should not be started just on teh basis of the symptoms.A patient must undergo a good quality Ultrasound, Serrum PSA levels. If the PSA levels are high or the prostate on ultarsound appears suspicious for cancer, then it should be followed up for MR Imagine or a Magnetic Resonance Imaging (MRI) of the lower abdomen or the Pelvis and depending upon that sometimes the PSA levels are high then the patient should undergo the Biopsy of the prostate.

Once the diagnosis is established, we stage the disease. The staging of disease will depend upon whether it is only confined to the stages of Prostates or it is going beyond the prostate. Most common side of other organ involvement is the lower back ro the back bone. The good thing about these cancers is that more than 80% of the these are low grade and they grow over many years. So, there is no need to immediately panic and if it is organ confined then it can be treated and cured with either surgery or direct with radiations. We have got Robotic surgery, very high resolution as well as very conformal radiation techique available with us whioch can treat the local forms of prostate cancer. Many of the people will be cured of the disease. Even in advanced cases nowadays with the advances and the oncology, the disease can be conbtrolled for many years and the patient can be asymptomatic.

People are living healthy and normal lives as they were living before getting this disease. So you need to be aware of this entity because it is on eof the common cancers in men. But if we and our physician is alert, they will definitely rule this out.

So, this is all I wanted to tell you about Carcinoma Prostate. Do not fear about the cancer. Many advances are happening on every day basis in the cancer managemnety and the future looks very promising to me.

If you need any help for Carcinoma Prostate or if you know someone who need any help for the same, you can contact me on my email which is sajjanrajpurohit@yahoo.com or you can contact me through Lybrate.

If you want to take an appointment, I sit in Rajeev Gandhi Cancer Institute, South Delhi.

Thank you.

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