Prostate Cancer Treatment Treatment Cost in India

The prostate gland is found only in males and it is responsible for making fluid which is part of the semen produced by males. Prostate cancer begins when cells in the prostate gland grow uncontrollably.  The gland is situated below the bladder, right in front of the rectum. The size of the prostate will vary with age. Among younger men, the size is like that of walnut while in older men it is larger. There are glands situated right behind the prostate named seminal vesicle responsible for the fluid content of the semen.  The urethra carries the urine and semen out of the body via the penis right through the center of the prostate.

The protein that is excreted by the prostate is called prostate-specific antigen or PSA which helps in the retention of semen in its liquid state. Any excess of this protein found in the blood is considered as the first sign of prostate cancer. A family history of prostate cancer can be considered as one of the trigger factors for some men to develop prostate cancer.

There are different types of prostate cancer found and they have been categorized below:

Most of the prostate cancers are adenocarcinomas. These develop from the gland cells that make the fluid which adds up in the semen. Some other types of cancer found in the prostate are

• Sarcomas
• Neuroendocrine tumors
• Small cell carcinomas
• Transitional cell carcinomas

The other types of cancer in the prostate are quite rare. Prostate cancer victims are usually found to be suffering from adenocarcinoma. There are some prostate cancers that can grow, and they spread very quickly but most of them tend to grow gradually.

Some of the possible precancerous conditions of the prostate can be found when a man undergoes a prostate biopsy where small pieces of the prostate are removed to be observed under the microscope.

Prostatic intraepithelial neoplasia (PIN): There are variations found under a microscope when prostate gland cells are viewed. But then abnormal cells do not resemble the way cancer cells usually grow. Based on the abnormal patterns of the cells they are classified as below:

• Low-grade PIN: here the cells look almost normal
• High-grade PIN: In this case, the patterns look abnormal

In many men, the low-grade PIN is found to be developed at a very young age but then they do not necessarily grow into prostate cancer. The link between the low-grade PIN and Prostate cancer is still not so clear. But if the high-grade PIN is detected in the biopsy sample then there is a 20% probability that there is cancer in other parts of the prostate.

Proliferative inflammatory atrophy (PIA): The prostate cells look smaller than the normal ones and inflammation signs are observed in the region. PIA is not exactly cancer, but researchers are of the view that it may lead to high-grade PIN or sometimes prostate cancer directly.

Symptoms of prostate cancer are: Usually, early-stage prostate cancer is difficult to detect and until unless it grows and presses through the urethra and affects the way a man urinates, it is difficult to understand its manifestations. When it grows more intense then other symptoms are observed which includes back pain, pelvic ache, blood found in semen and urine and unaccounted loss in weight.

A doctor will do a physical examination and enquire about the medical history of the patient. If abnormal levels of PSA are found in the blood then further diagnosis will be carried out like

• Digital rectal examination or DRE where manually with fingers, doctor checks for abnormalities in the prostate. 
• Biomarker test where blood or urine, tissues are checked.
• Biopsy: where some tissue will be scraped off to observe for abnormalities in the prostate
• For a check of further spread or metastasis, doctors can ask for  CTor an MRI scan.

In this section, we shall come to know the standard treatment care available for prostate cancer. A multidisciplinary team of doctors works together to provide an overall plan for treatment. The treatment options chosen are dependent on the stage of cancer, side effects associated and patients’ preferences.

Early-stage prostate cancer (stages I and II): Cancer development is typically slow at this point and health problems, or after a long time any signs can surface. Brachytherapy or radiation therapy with surgical options can be suggested at this stage as well. Men with higher Gleason score may get cancer to develop rapidly.

Locally advanced prostate cancer (stage III): In this condition, men should undergo radiation therapy and receive ADT which is effective in the least amount of time for controlling the disease.

 Among older men watchful waiting is recommended if the symptoms have not surfaced properly.

Local treatments:  Local care attempts to eliminate the condition from any particular area of the prostate. Both therapies include surgery and radiation therapy. When cancer itself has spread to other areas so a systematic approach to diagnosis must be taken.

Surgery: In surgery, the prostate is removed and along with it some healthy tissues around it are also removed.  Surgical options are as below:

• Radical open prostatectomy:  the entire prostate gland and seminal vesicles are removed in this kind of surgery. The lymph nodes present in the pelvic area can also be removed. Sexual functions can get affected in this procedure. A nerve-sparing surgery whenever possible should be opted to protect the nerves that help control erectile functions and orgasm. Even urinary incontinence(involuntary leakage of urine) is a probable side effect of radical prostatectomy. Penile implants, drugs or injections should be considered for fixing the above problems.

• Robotic or laparoscopic prostatectomy: This process is far less invasive and can shorten the time of recovery. Through a small keyhole incision, a camera and instruments are inserted into the abdomen of the patient. The prostate gland is now removed by the robotic instruments as directed by the surgeon and some surrounding tissues. This causes less bleeding and discomfort, but the side effects are quite similar to the above procedure.

• Bilateral orchiectomy: Here the testicles are surgically removed. Men who are relatively healthier and younger can benefit better from this kind of surgery. They are also less likely to develop permanent erectile dysfunction and urinary incontinence compared to older men.

Radiation therapy: Here high energy rays are used for the destruction of cancer cells and a doctor shall schedule a total regimen with a specific number of sessions of various kinds of radiation for treating prostate cancer.

External beam radiation therapy: A machine is located aiming the beam of x-rays focused on the specific region of the prostate gland. Computers can precisely demarcate the zone which requires the beam treatment. In this way, it prevents healthy tissues from becoming a target.

Brachytherapy: Here a radioactive source is put into the prostate. The sources known as seeds radiate off rays and can be left there for a very short period of time(30 minutes)  emanating doses at a very high rate or can be kept longer ( 1 year or permanently)  with low dose rate. This treatment can be compiled with ADT or external beam radiation therapy.

Intensity-modulated radiation therapy (IMRT): They make use of CT Scans in order to form a 3D picture of the prostate just before the treatment. The size, shape and exact location is found to determine the dose of radiation required for the prostate without having a damaging effect on other organs.

Proton therapy: It is also an external beam radiation therapy making use of protons instead of x-rays. They are released at a very high energy level to destroy the cells of cancer in the prostate. But this therapy is a bit more expensive.

The side effects of radiation therapy usually include bowel function problems, sexual functions, diarrhea or constipation, rectal bleeding, and fatigue. But they usually die out after the radiation therapy is stopped.

Focal therapies:  They are less invasive treatment options and are helpful in destroying small-sized tumors in the prostate and can leave the remaining prostate gland intact. They can make use of heat and cold for the treatment but still, they have not been endorsed as standard options of treatment yet.

Cryosurgery, Cryotherapy or Cryoablation are kinds of focal therapy: A metal probe is inserted through an incision between the area of rectum and scrotum and the skin sac which contains the testicles. Its side effects and even total effectiveness on health improvement is still not known and hence not exactly considered as an established therapy yet.

High intensity focused ultrasound (HIFU): This is a heat-based type of focal therapy. An ultrasound probe is inserted inside the rectum and when sound waves are directed at the cancerous parts of the prostate gland these cells are destroyed with very little damage caused to any other parts of the prostate or surrounding tissues.

Systemic treatments: Treatment like chemotherapy and ADT are used to reach and treat cancer cells that are found throughout the body. This type of treatment is referred to as systemic treatment.

• Androgen deprivation therapy (ADT):  Cancer growth is triggered by male sex hormones called androgens. By lowering their levels, the growth of cancer can be controlled to an extent. The most common kind of androgen is called testosterone. The levels of these hormones in the body can be decreased by removing testicles surgically and is also known as surgical castration or by consuming drugs that can stop the testicles from functioning which is called medical castration. The time period of continuing ADT can vary significantly from 4 to 36 months. There are specific types of ADT which are discussed below:
•  LHRH Agonists: Luteinizing hormone-releasing hormone. These agents prevent the testicle from receiving messages sent by the body to produce testosterone. By blocking those signals testosterone production is affected. The effect is reversible, so once they are stopped then again testosterone production starts. These are like small implants placed under the skin. These can have side effects like pain in the bone if cancer has already spread to the bones.
•  LHRH Antagonist: This is a gonadotropin-releasing hormone that stops the testicles from producing testosterone but unlike LHRH they reduce the levels of testosterone more quickly. As a side effect, it can cause allergies.
• Anti-Androgens: This works by binding testosterone to so-called androgen receptors which are like chemical structures of cancer cells that allow testosterone and other hormones in males to make an entry in the cells.  This is useful for patients who have hormone-sensitive prostate cancer.
• Combined androgen blockade: This technique is combined with LHRH or bilateral orchiectomy to maximize the effects of hormone blockade. Adrenal glands can still make some androgens even if testicles are no longer functioning.  Many healthcare providers feel that this combination approach allows patients to live longer.
• Intermittent ADT: In the last 2 decades intermittent ADT’s effects have been studied where ADT is given for specific time like 6 months and then it is temporarily stopped for a while allowing testosterone levels to rise. This method reduces the side effects associated with ADT, but its effects are still not established. Side effects of ADT include loss of sexual desire, hot flashes, erectile dysfunction, depression, gynecomastia or growth of breast tissues, weight gain, cognitive dysfunction and loss of memory, muscle mass loss and osteopenia or bone thinning.

Chemotherapy: This is the use of drugs for the destruction of cancer cells by bringing a stop to their abilities to divide and growing further.

For the treatment of the prostate, cancer chemotherapy is done through an intravenous tube placed. It is helpful among patients with advanced or castration-resistant prostate cancer. It will comprise of a regimen of sessions with specific doses. Drugs like Docefrez or Taxotere can be combined in the initial stage of chemotherapy.

The side effects of chemotherapy cannot be ignored, which include diarrhea, nausea, vomiting, sores in mouth and throat and loss in hair and appetite. But the effects of chemotherapy die down with the stoppage of the therapy.

Palliative/supportive care: This is to relieve the patient from the symptoms and prevent side effects for the overall plan of treatment. This also helps patients in coping with anxiety, stress, and depression. Relieving pain is very much possible with proper management of prostate cancer. Overall it helps in improving the quality of life led by the patient.

The surgery costs of prostate cancer start from $4500 and sessions of radiation therapy and chemotherapy can vary from $400 to $1400 per session depending on various factors which is less than half the cost that may be incurred in the USA with similar amenities and quality of treatment.