Prostate Cancer Treatment in Mumbai, India

Prostate cancer is a type of disorder that affects the prostate, a walnut-shaped gland that produces a fluid used to nourish and transport sperm. The prostate is part of the male reproductive system, located in front of the rectum and below the bladder. Prostate cancer is characterized by the uncontrolled growth of cells in the prostate gland, which, left untreated, may spread to neighboring tissues and other body parts.

Prostate cancer commonly occurs in men aged 60 years or older. It is among the 3rd most prevalent cancers in Delhi and Mumbai, and the number of men suffering from the disease is expected to increase to more than 47,000 by 2025.

Part of the male reproductive system, the prostate gland is located below the urinary bladder. Prostate cancer affects the prostate gland and can even be fatal, if not detected early on. Timely detection can help in successful prostate cancer care treatment before it spreads.

Nanavati Max Hospital in Mumbai is amongst the leading hospitals in the city, offering early detection and prostate cancer treatment options. The Department of Urologic Oncology at Nanavati Max Hospital uses state-of-the-art facilities and cutting-edge technologies for prostate cancer treatment. The hospital’s specialised multidisciplinary team of highly qualified medical professionals, work tirelessly to deliver superior, comprehensive and personalised care to prostate cancer patients, enabling them to overcome the challenges of the disease.

Prostate Cancer Symptoms

Prostate cancer does not present any symptoms in the early stages. If there are any symptoms, they are often mistaken for urinary symptoms of benign prostatic hyperplasia (BPH) or an enlarged prostate. Screening for prostate cancer by checking the prostate-specific antigen (PSA) levels in the blood can help to detect the disease. High PSA levels are an indication that the person may have cancer.

Some of the symptoms of prostate cancer include:

• Urge to urinate frequently or urgently, particularly at night
• Difficulty to start urinating and keep urinating
• The sluggish flow of urine
• Starting and stopping urine flow
• Urinary incontinence (loss of control of the bladder)
• Bowel incontinence (loss of bowel control)
• Haematuria (blood present in the urine)
• Hematospermia (blood in the semen)
• Dysuria (pain or burning when passing urine)
• Painful ejaculation
• Erectile dysfunction
• Dull pain in the pelvis
• Pain in hips, upper thighs or back
• Loss of appetite

Even in advanced stages, individuals may or may not have any symptoms. The symptoms depend on the size of the growth and the areas in which the cancer has spread. Some of the advanced signs of prostate cancer include:

• Tiredness
• Unexplained or sudden weight loss
• Pain in the bones

Prostate Cancer Causes

It is not known what exactly causes prostate cancer in men. Prostate cancer occurs when there are changes in the glandular cells. Changes in the prostate gland cells are generally quite slow, but over time, they can become cancerous. Fortunately, prostate cancer can be diagnosed and treated before it metastasizes (spreads to other parts of the body). Cancer cells that grow and spread are known as high-grade cells, whereas the ones that do not grow or spread are called low-grade cells.

Some risk factors can increase the chances of an individual getting prostate cancer. These include factors such as age, family history, genetic factors, ethnicity or race and diet. However, if the person has one or more of the risk factors, it does not mean that they will get the disease.

Prostate Cancer Types

There are different types of prostate cancers and the form of cancer reveals the kind of cells the cancer develops in. The most prevalent prostate cancer type is adenocarcinoma. They usually start from the gland cells that produce prostate fluid. There are two subtypes of adenocarcinoma:

• Acinar Adenocarcinoma: This is more common and forms in the gland cells lining the prostate gland.
• Ductal Adenocarcinoma: A more aggressive type of cancer that spreads very quickly, ductal adenocarcinoma forms in the cells lining the prostate gland ducts or tubes.

Some of the other rarer types of prostate cancers are:

• Small Cell Carcinomas: These cancer cells develop in the small round cells in the prostate gland. Small cell carcinomas are aggressive and spread quickly to other parts of the body. These carcinomas are quite rare and comprise around 1% of prostate cancers.
• Transitional Cell Carcinomas: Also called urothelial cancer, transitional cell carcinomas develop in the bladder or urethra (the tube that removes urine from the body) and spread to the prostate gland. In rare cases, it may start in the prostate gland and spread to the bladder and surrounding tissues.
• Neuroendocrine Tumours: Neuroendocrine prostate cancer (NEPC) is a highly aggressive type of prostate cancer that usually appears when regular prostate cancer has advanced and become resistant to treatment.
• Sarcomas: Also known as soft-tissue prostate cancer, prostate sarcoma is extremely rare. It forms outside the prostate gland, in the supportive tissue, i.e., the nerves, muscles blood vessels and fat.

Prostate Cancer Stages

Doctors assign the stage of prostate cancer based on the Gleason scoring system and TNM staging system. The following are the stages of prostate cancer:

Stage I- cancer is typically slow-growing and cannot be felt easily.

Stage II- The tumor is small, but there is an increased risk of growth and spread to neighboring tissues. Stage II can be further classified into stages IIA, IIB, and IIC.

Stage III- In stage III, the tumor is classified as high grade, and it is likely to spread to other parts of the body. It can be subdivided into stages IIIA, IIIB, and IIIC.

Stage IV- Stage IV is characterized by the spread of the tumor to other parts of the body. Depending upon the affected body part, it is classified into stage IVA and stage IVB.

Prostate Cancer Diagnosis

There are different types of tests to diagnose prostate cancer. The cancer doctor considers factors such as the patient’s age, overall health, signs and symptoms, type of cancer suspected and earlier test results before recommending a test.

Screening Tests for Prostate Cancer

Screening tests detect abnormalities and identify the presence of cancer before the person has any symptoms. If the screening tests show any abnormality, then further tests are recommended to determine if the person has prostate cancer or not.

Screening tests for prostate cancer include:

• Digital rectal exam (DRE)
  • A DRE involves the doctor inserting a lubricated, gloved finger into the rectum and examining the prostate.
  • This is usually done as a screening test to look for any abnormalities in the size, shape or texture of the prostate gland indicating cancer.
• Prostate-specific antigen (PSA) blood test
  • The blood sample is tested for PSA, a protein produced by the prostate gland. Higher-than-normal levels of PSA may indicate prostate cancer.
  • PSA can be used for men diagnosed with prostate cancer to:
    • Decide if any other tests are required.
    • Determine the stage of cancer.
    • Check the effectiveness of the cancer treatment.
    • Monitor for recurrence of cancer post-treatment.
• Collecting a sample of prostate tissue
  • A sample of prostate tissue is collected by inserting a thin needle into the prostate. The sample is then tested in the lab.
  • Prostate biopsy or sample tissue collection is usually done to check for the presence of cancer cells in the prostate gland.

Imaging Tests for Prostate Cancer

Different imaging tests make use of X-rays, sound waves, magnetic fields or radioactive compounds to detect cancer cells, check the spread of prostate cancer to other parts of the body or help in prostate cancer treatment or biopsy.

• Magnetic resonance imaging (MRI)
  • An MRI scan uses strong magnets and radio waves to produce detailed images of the soft tissues in the body. It allows the doctor a clear view of the prostate gland and surrounding areas.
  • MRI scans can help:
    • To determine if a person should have a prostate biopsy if their screening test is abnormal or if they have prostate cancer symptoms.
    • To locate the areas that may contain cancer cells and target them while doing a biopsy.
    • To guide needles into the prostate while doing a biopsy.
    • To determine if the prostate cancer has spread to the surrounding areas and the extent of spread.
• Transrectal Ultrasound (TRUS)
  • In this procedure, a finger-sized probe is lubricated and inserted into the rectum. The probe emits sound waves which create echoes to create an image of the prostate gland.
  • TRUS is used to:
    • View suspicious portions of the prostate for people with abnormal PSA and DRE results.
    • Guide needles into the prostate when doing a prostate biopsy.
    • Measure the prostate gland’s size to check the PSA density.
    • Guide in treatments like cryotherapy or internal radiation therapy (brachytherapy).

Biopsy Tests for Prostate Cancer

• If there are any abnormalities in the DRE, PSA or any other test, then the individual will need a prostate biopsy. The procedure involves the removal of a small sample of prostate tissue with a thin hollow needle, which is then viewed under the microscope.
• Prostate biopsy is mainly used to diagnose prostate cancer.

Prostate Cancer Prevention

Although there are no proven methods to prevent prostate cancer, making healthy lifestyle choices can help to reduce the risk.

Preventive Measures for Prostate Cancer

Some strategies to reduce the risk of prostate cancer include:

Quit Smoking

Smoking at the time of diagnosis of prostate cancer is linked to a higher risk of death. Quitting smoking can help reduce the risk of prostate cancer and can improve overall health.

Get Regular Prostate Screenings

Regular prostate cancer screenings are crucial, especially for individuals at higher risk due to their ethnicity or a family history of the disease. This can help in early detection and treatment.

Exercise Regularly

Exercising regularly not only helps lose weight but also helps improve immune function and reduces inflammation. All these factors can help prevent prostate cancer.

Maintain a Healthy Weight

Being overweight or obese can increase the risk of developing prostate cancer. Maintaining a healthy weight can help to reduce the risk of prostate cancer.

Eat a Nutritious Diet

Eating a healthy and nutritious diet with more vegetables and fruits, soy, green tea, dietary fats such as saturated and trans fats and avoiding charred meat can all help reduce the risk of prostate cancer.

Prostate Cancer Treatment

There are various types of prostate cancer treatments including:

Surveillance

If the doctor feels that a person’s prostate cancer will not grow quickly, then they may decide to wait and watch to see if any symptoms develop. This can be done in two ways:

• Active surveillance
  • This involves techniques and procedures like screening, DRE, PSA, biopsies and scans once in 1-3 years to determine the rate of cancer growth. Treatment is given only if the prostate cancer causes any symptoms or grows.
  • Active surveillance is ideal for slow-growing prostate cancer, which does not cause any symptoms and is present only in the prostate.
• Watchful Waiting
  • This technique involves monitoring the patient’s condition closely and is generally used for older men with cancer that cannot be cured with prostate cancer treatment.
  • Watchful waiting does not involve a lot of testing. It focuses on managing the cancer symptoms and improving the patient’s quality of life, instead of attempting to eliminate the cancer.

Radiation Therapy

Radiation therapy destroys the cancer cells by exposing them to radioactive sources or high-energy rays. There are 2 radiation therapy techniques – internal and external radiation therapy.

• Brachytherapy
  • In internal radiation or brachytherapy, radioactive sources like pellets or seeds are placed near or inside the cancer cells. They deliver a low dose of radiation and destroy the cancer cells.
  • This technique is used to treat prostate cancer that is inside the prostate gland and has not spread.
• External Beam Radiation Therapy
  • In this method, high-energy rays like X-rays or protons are directed onto the cancer cells from outside the body.
  • This method is useful in destroying cancer cells that are confined to the prostate gland, killing any cancer cells remaining after surgery and relieving symptoms like pain.

Systemic Therapies

These therapies destroy or prevent the growth of cancer cells by spreading through the body. They are used if the cancer has spread outside the prostate gland.

• Chemotherapy
  • Chemotherapy uses drugs to kill cancer cells by entering the bloodstream and spreading through the body.
  • It prevents the growth of cancer cells by either stopping them from multiplying or killing them.
• Hormone therapy
  • In hormone therapy, medicines are used to reduce the testosterone levels in the body or prevent it from reaching the cancer cells.
  • In this method, the testosterone in the body is stopped from encouraging the growth of cancer cells.
• Targeted therapy
  • This treatment method focuses on mutations or genetic changes that change healthy cells into cancer cells.
  • Targeted therapy uses BRCA gene mutations to target specific prostate cancer cells and destroy them to stop them from growing and dividing.
• Immunotherapy
  • Immunotherapy uses substances produced by the body or lab-made substances to boost or restore the natural defences of the body against prostate cancer.
  • The treatment makes use of the individual’s immune system to identify and combat cancer cells. This technique is often used for recurrent or advanced cancer.

Surgery

Surgery is used for prostate cancer treatment when the cancer is confined to the prostate gland and has not spread. This involves the radical prostatectomy (removal of the prostate gland) and also some lymph nodes and tissue in the surrounding area.

• Open radical prostatectomy: This technique involves removing the prostate gland by making an incision in the abdomen.
• Robotic radical prostatectomy: A less-invasive technique, robotic radical prostatectomy is performed by a robot system and via multiple small incisions.

Freezing or Heating Prostate Tissue

Also known as ablative therapies, these techniques use heat or cold to destroy the prostate gland tissue. These techniques are generally used when surgery is not an option or treatments such as radiation therapy have failed.

• Freezing prostate tissue: The technique of cryotherapy or cryoablation involves freezing the prostate tissue by using very cold gas and then allowing it to thaw. The repetition of the freezing and thawing process destroys the cancer cells and tissues in the surrounding area.
• Heating prostate tissue: This treatment uses ultrasound energy to heat the prostate tissue and kill the cancer cells.

Focal Therapy

Typically used for low-risk prostate cancer that has not spread, focal therapy kills the cancer inside the prostate gland.

• Laser Ablation: This technique uses high heat targeted at the cancer cells in the prostate and kills them.
• Photodynamic Therapy: This prostate cancer treatment uses medications that make the cancer cells in the prostate highly sensitive to specific wavelengths of light. When exposed to the light wavelengths, it destroys the cancer cells.
• High-Intensity Focused Ultrasound (HIFU): The technique uses high-intensity sound waves that produce high heat that destroys the cancer cells in the prostate.
• Cryotherapy: In this treatment, cold gases are used to freeze the cancer cells in the prostate gland and destroy them.

Prostate Cancer Risks

In general, all men are at risk of developing prostate cancer. However, apart from being male, some of the other risk factors of the disease include:

• Age: The risk of prostate cancer increases with age, especially after 50.
• Family History: A person having a close relative with a prostate cancer history is at a higher risk of getting it.
• Ethnicity or Race: Prostate cancer is more common in African-Americans compared to White people. Hispanic and Asian people are at a lower risk for the disease compared to Black or White people.
• Genetic Factors: Genetic features such as changes in BRCA1 and BRCA2 genes can increase the prostate cancer risk. People with Lynch syndrome are also at a higher risk for the disease.
• Diet: Some types of diets such as a diet high in calcium may increase the risk of prostate cancer.

Other factors that may increase prostate cancer risk include fad diets, smoking, drinking alcohol, obesity, sexually transmitted infections, prostate inflammation and exposure to chemicals.

Prostate Cancer Complications

Prostate cancer complications occur if the prostate gland becomes very large and affects the urethra. However, since prostate cancer grows very slowly, this complication can occur after several years. Some of the complications of the disease include:

• Urinary incontinence
• Erectile dysfunction
• Metastasis or spread of the cancer to other parts
• Recurrence of the cancer
• Death

Conclusion

Prostate cancer is a common disease affecting men and can be fatal if not detected early and treated. Fortunately, the treatment for prostate cancer has progressed significantly. The advancements in screening methods, radiation therapy, surgical treatments and targeted therapies have helped to improve patient outcomes, as well as quality of life. However, the importance of early screening and seeking timely medical treatment should not be undermined. It can be the key to managing the disease effectively.

Frequently Asked Questions

1. Is Prostate Cancer Serious?

If prostate cancer is slow-growing and is confined to the prostate gland, then it is not too serious. However, if the cancer is aggressive and spreads quickly, this is a serious condition that needs medical intervention.

2. Is Prostate Cancer Treatment Successful if Detected Early?

The success rate of prostate cancer treatment depends on various factors, including the stage of cancer at the time of diagnosis, the treatment method used, and the patient's overall health. Early detection and treatment of prostate cancer offers the best chance of positive, long-term outcomes.

3. What Potential Side Effects Can Patients Expect from Prostate Cancer Treatments?

The side effects of prostate cancer treatment depend on the treatment method. Surgery may cause urinary incontinence, erectile dysfunction, and bowel problems. Radiation therapy may cause fatigue, skin irritation, and bowel problems.

4. Can Prostate Cancer be Treated Without Surgery or Radiation Therapy?

Yes, prostate cancer treatment is possible without surgery or radiation therapy. Watchful waiting and active surveillance may be recommended for patients with early-stage prostate cancer or those with other health problems that make surgery or radiation therapy too risky.

5. What's The Typical Recovery Time After Undergoing Prostate Cancer Treatment?

Recovery time from prostate cancer treatment varies depending on the treatment method used and the patient's overall health. Some patients may recover within a few weeks, while others may take several months.

6. What is The Best Way To Remove Prostate Cancer?

The best way to remove prostate cancer is by removing the entire prostate gland (radical prostatectomy) and the lymph nodes around it.

7. Which Treatments are Frequently Recommended for Prostate Cancer?

Surgery, radiation therapy, chemotherapy and hormone therapy, along with close monitoring and observation, are the most common treatment modalities for prostate cancer. The treatment plan depends on factors such as the stage of the cancer, the patient's age and overall health.

8. Can You Live A Long Life After Prostate Cancer?

The 5-year survival rate after a prostate cancer diagnosis is about 100%, the 10-year survival rate is around 98% and the 15-year survival rate is about 95%.

9. How Do You Stop Prostate Cancer From Growing?

Prostate cancer treatments like radiation therapy, systemic therapies, surgery, focal therapies and heat and cold therapies can help stop the growth of prostate cancer.

10. What Foods Can Stop Prostate Cancer?

Pulses, soybeans, green tea, tomatoes, foods containing lycopene, pomegranate, berries like strawberries, blueberries and cranberries and cruciferous veggies like cauliflower, cabbage and broccoli can help with prostate cancer.

11. What Kills Prostate Cancer Cells Naturally?

While there are no proven methods to kill prostate cancer cells naturally, the foods mentioned above can help recover from the disease and prevent it from recurring.

12. Can Prostate Cancer Be Cured For Life?

If prostate cancer is detected and treated in stages I, I and III (local and regional stages), the individual can be free of the disease after 5 years.

13. At What Size Of Prostate Requires Surgery?

Persons with very large prostates (more than 80gms) with significant symptoms require surgery.

14. How Much Does Prostate Cancer Treatment Cost In Mumbai?

Prostate cancer treatment can vary between approximately INR 1,00,000 to INR 10,00,000 in Mumbai.

15. Can Prostate Cancer Be 100% Cured?

If detected early and treated quickly, prostate cancer is 100% curable.

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