Treatments Related to Various Stages of Prostate Cancer

Prostate cancer is a form of cancer that grows in the prostate, a gland in the male reproductive system. Prostate cancer is most common in the developed world with cumulative rates in the developing world and it is the sixth leading cause of cancer among men globally.

Based on the three factors such as TNM stage, PSA and Gleason score, the patients are classified into high, intermediate and low risk groups. The low risk patients are usually treated with radical prostatectomy or radiotherapy alone.

Patients who are classified in intermediate risk disease are usually treated with radiotherapy and a short duration (less than 6 months) of hormonal therapy. It depends upon surgeon’s decision to prefer for robotic radical prostatectomy or not. Although the role of surgery in these patients remain uncertain, and the patient with high risk disease are usually treated with radiotherapy and a long duration of hormonal ablation. Many high risk patients are not cured by this treatment.

Stages of Prostate Cancer Using TNM System:

Prostate cancer is staged using the TNM system. This is used all over the world. It separately assesses the tumor (T), lymph nodes (N) and secondary cancer (metastases – M).

  • T – For tumor — describes the size of the main area of prostate cancer.
  • N – For nodes — describes whether cancer has spread to any lymph nodes and to what extent.
  • M – For metastasis — means distant spread of prostate, for example, to the bones or liver.

Different Stages of Prostate Cancer:

Stages of Prostate CancerThere are four Stages of Prostate Cancer that we have discussed it below. Following are the different Stages along with their treatments.

Stage I

In stage I, cancer is found in the prostate only. The cancer is found by needle biopsy or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower. It is found in one-half or less of one lobe of the prostate. It cannot be felt during a digital rectal exam and is not visible by imaging. They usually grows very slowly and do not show any symptoms at the early stage. The cancer is very small and completely inside the prostate gland, which feels normal during a rectal examination.

Treatment:

  • Surgery to remove the prostate gland (called radical prostatectomy). Since it is too small, surgery is not preferred at this stage.
  • Watchful Waiting or Active Surveillance. In this therapy, the doctors closely watch the tumor to see if it causes any symptoms or it appears to be growing. Common test such as PSA is usually done in this method.
  • Radiation Therapy: It uses high frequency x-ray beam to kill prostate cancer cells or to refrain them from being divided and grow rapidly.

Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. If it is not treated then it is likely to spread outside of prostate. If the patient is so elder or having more complex diseases or after watchful waiting there are no any significant increase in growth of cancer tumor, then in such cases

Radical Prostatectomy and Radiation Therapy are the preferred options. Stage II is divided into stage IIA and stage IIB.

In stage IIA, cancer:

The PSA level is lower than 20 but higher than 10 and the Gleason score is 6-7. It is found by needle biopsy or in a small amount of tissue during surgery for other reasons.

In stage IIB, cancer:

Such cancer is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10. In some cases, the tumor has not spread outside the prostate and such tumors cannot be felt during a digital rectal exam and not visible by imaging. In such cases, the PSA level is 20 or higher and the Gleason score can range from 2 to 10.

Treatment:

  • Radiation therapy with ADT
  • Hormone Therapy: It is used to stop the production of testosterone and all androgens either temporarily or permanently. Prostate cancer grows when it is exposed in presence of testosterone, so this therapy is used to stop its production.
  • Radical prostatectomy and sometimes proceeded by hormonal therapy. In some cases the lymph nodes are removed.
  • Brachytherapy and external beam radiation combine. The radiation theraphy also includes follow up of hormone therapy.

Stage III

In this stage, the cancerous cell has significant growth. Cancer tumor has spread beyond the prostate gland but not has reached to bladder, lymph nodes, rectum or any other organs. Some times for elders doctors prefer to go for watchful waiting stage. This is preferred only if patient is having many sever complications or other illness.

The PSA can be any level and the Gleason score can range from 2 to 10.

Treatment:

  • External beam radiation plus hormone therapy
  • Radical prostatectomy in selected cases. Many times pelvic lymph nodes are also removed. Radiation therapy may be followed after this surgery.
  • In some cased only hormone therapy is preferred.

Stage IV

This is the final stage of the cancer and usually it is not curable. It has grown into the bladder or rectum, or has spread to the lymph nodes or another part of the body. It may spread to the bones, liver or lungs type of distant places. In this case, removing any part of the body will not solve the problem. It is preferred to wait and watch for the elder person.

Treatment:

  • Hormone therapy
  • Chemotherapy
  • External beam radiation plus hormone therapy (in selected cases)
  • Surgery such as TURP which helps in reducing symptoms such as bleeding
  • Some reliving treatments are also done to reduce symptoms such as bone pain.

We have discussed here different stages of prostate cancer along with their Prostate Cancer Treatment.

For more information you can visit our website: http://www.mpuh.org/centreforroboticsurgery/

Prostate Cancer Treatment in India

For Prostate cancer treatment robotic surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the gland (stage T1 or T2 cancers).

The main type of robotic surgery for prostate cancer is known as a radical prostatectomy surgery. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles. A radical prostatectomy can be done in different ways.

A less invasive surgical option – Laparoscopy is available for urologic surgery that uses small incisions. But, due to some the limitations of laparoscopy procedures it is not suggested
for more complex urologic surgeries.

One of the most modern and effective way of surgery is robotic radical prostatectomy surgery. It is a minimally invasive approach, using the latest Da Vinci Robotic Surgical System and
it is ideal for delicate urological surgeries.

Prostate Cancer Surgery

Robotic Surgery in India

Advantages of Robotic Prostatectomy:-

Robotic Prostate Surgery:

Clinically Superior Results
Reduced Risk of Complications
less post operative pain
Less Scarring
Less blood loss
A shorter hospital stay
Erectile Function
Faster recovery and return to normal activities
Fater return of urinary continence

Dr. Mahesh desai is the head of robotic surgery for prostate, kidney and urinary bladder cancer at Muljibhai patel urological hospital ( Centre for Robotic Surgery) in India. He is Top Urologist in world. It is the first super specialty hospital in India dedicated to Urology. We serve our patients for more than 35 years and we are popularly known as “Nadiad Kidney Hospital in India”.

Patient’s Testimonial on Importance of Exercise after Robotic Prostatectomy by Mr. Vinesh Antani – A Renowned Gujarati Author

By Mr. Vinesh Antani – A Renowned Gujarati Author

Dr. Mahesh Desai, the Medical director of famous MPUH hospital – Nadiad, has explained me in details about the side effect of prostate removal, when he decided to go for an operation for my prostate cancer. The important thing for me was to know that a patient loses the control over urinate after the surgery, and that lasts for indefinite period – it can be for a few days, weeks or even for a few months. Once the prostate is removed, and if the muscles are not strong enough, patient will not be able to have control over urinate.

For the purpose, Dr. Mahesh Desai strongly recommended me to do exercise regularly. The physiotherapist – Dr. Vijay gave me enough training for all type of exercises. These exercises are very simple, but patients have to do them regularly – before and after the surgery. Dr. Vijay has repeatedly reminded this instruction and I started following it.

Dr. Mahesh Desai performed my surgery on 28th May, 2013. After the surgery, all the doctors were regularly following up with me and all of them – including Dr. Desai have strongly recommended to continue the exercise. The physiotherapist – Dr Vijay used to visit twice a day, and kept on guiding about the exercise. Even the nursing staff reminded the same. I was worried about urine leakage. I followed the advice of Dr. Mahesh Desai and his team about the exercise quite sincerely. At hospital, I had nothing to do that is why I kept on exercising throughout my stay.

The catheter was removed on the seventh day after my surgery. Now, the urine was supposed to come out naturally. I was at a point, for which I was afraid of the most, when I couldn’t control the urine. Luckily, after few hours urine started naturally. I was very worried about controlling urine and I was praying God to take me out of this situation as early as possible. As per the instruction and the guidance given by expert team of doctors, I continued my exercise regularly. After removal of the catheter urine was passing naturally. I could feel urge of the urination. I could stand up and reach to toilet. Gradually I could hold urine up to four hours then five hours and finally up to six hours!! I was amazed that there was no single incident of urine leakage during the entire day. I made doctors aware about it and they were happy as well. When Dr. Mahesh Desai came for a visit in evening, I informed him about it. He was very happy and he added that “this is the result of your regular exercise”. It’s been 15 days, when I am writing this, since the catheter is removed. I still do exercises regularly and follow doctor’s instruction very carefully. I am glad that there is no single incident of urine leakage till now.

Friends, I just want to tell you one thing. Like every patient wants the best doctors for their treatment, even doctors want their patients to follow all their instructions. My own experience of following doctor’s instructions, kept me away from shameful situation of urinary incontinence. Such things give big relief to the patient. So every patient should follow the doctors’ advice very strictly and do the exercise regularly.