Men with Prostate Cancer have many Treatment Options : Best and Advanced Treatment of Prostate Cancer in India

Prostate cancer generally affects men over 50 and is rare in younger men. It’s the most common type of cancer in men. It differs from most other cancers in the body, in that small areas of cancer within the prostate are very common and may stay dormant (inactive) for many years. Most of these cancers grow very slowly and so, particularly in elderly men, are unlikely to cause any problems. In a small proportion of men, prostate cancer can grow more quickly and in some cases may spread to other parts of the body, particularly the bones.

Symptoms of Prostate Cancer

A man with prostate cancer may not have any symptoms. Symptoms of prostate cancer are often similar to those of benign prostatic hyperplasia (BPH). Men observing the following signs and/or symptoms should see their physician for a thorough examination:

• Urinary problems - Not being able to pass urine • Having a hard time starting or stopping the urine flow
• Needing to urinate often, especially at night
• Weak flow of urine
• Urine flow that starts and stops
• Pain or burning during urination
• Blood in the urine or semen
• Frequent pain in the lower back, hips, or upper thighs If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.

Diagnosis of Prostate Cancer

PDigital rectal exam (DRE) : The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas.

Prostate-specific antigen (PSA) test:A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate).

Transrectal ultrasound : A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. Transrectal ultrasound may be used during a biopsy procedure.

Biopsy :The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will examine the biopsy sample to check for cancer cells and determine the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread. 

There are 2 types of biopsy procedures used to diagnose prostate cancer:

Transrectal biopsy: The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide the needle.

Transperineal biopsy: The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate.

Staging of Prostate Cancer

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Some men may need tests that make pictures of the body:

Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film.

 CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis or other parts of the body. Doctors use CT scans to look for prostate cancer that has spread to lymph nodes and other areas. You may receive contrast material by injection into a blood vessel in your arm or hand, or by enema. The contrast material makes abnormal areas easier to see.

  MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread to lymph nodes or other areas.

Stage I  The cancer can't be felt during a digital rectal exam, and it can't be seen on an imaging study, such as ultrasound.

 Stage II: o The tumor is more advanced or a higher grade than Stage I, but the tumor doesn't extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram. It is detected either after a needle biopsy or surgery done for other reasons, i.e. resection of the prostate for benign enlargement.

 Stage III: o The tumor extends beyond the capsule (outer covering) of the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven't spread to the lymph nodes, bones or other organs.

 Stage IV: o The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles).

Advanced Treatment of Prostate Cancer

Men with prostate cancer have many treatment options. The treatment that's best for one man may not be best for another. Your doctor will make recommendations that are best for each individual. The options include active surveillance (also called watchful waiting), surgery, radiation therapy, cryotherapy, hormone therapy, and chemotherapy. You may have a combination of treatments. The treatment that's right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health.

Surgery: Surgery is an option for men with early (Stage I or II) prostate cancer. It's sometimes an option for men with Stage III or IV prostate cancer. Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment. After removing the prostate, the bladder is reconnected to the urethra (tube that men urinate through).

Robotic laparoscopicsurgery: The surgeon removes the entire prostate through small cuts . A laparoscope and a robot are used to help remove the prostate. Instruments are passed through the small cuts and are used to remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.

Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:

• Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. The incision typically is from the umbilicus (belly button) down to the pelvic bone. This is called a radical retropubic prostatectomy.
   
• Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
   

Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts , rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon see. Other instruments are passed through the small cuts. These instruments are used to remove the prostate.

TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. 

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The CyberKnife Robotic Radiosurgery System can treats both cancerous and non-cancerous tumors anywhere in the body

How Cyberknife RadioSurgery Works ?

As a non-invasive “operation”, CyberKnife has proven to be an effective alternative to surgery or conventional radiation for treating vascular abnormalities, tumors, functional disorders, and cancers with sub-millimeter accuracy. CyberKnife gives renewed hope and the possibility of a better quality of life, especially for patients with tumors previously diagnosed as inoperable, and for those who have already received the maximum amount of radiation through other treatment methods.

The CyberKnife uses non-invasive image-guided localization that is more convenient and less traumatic than other systems using the standard invasive stereotactic headframe (a rigid metal frame fixed to a patient’s skull for head immobilization and target localization). CyberKnife also uses an advanced, lightweight linear accelerator (LINAC), a device used to produce a high dose of radiation.

In addition, CyberKnife also has a robotic delivery system that not only provides the flexibility to reach areas of the body unreachable by other systems, but is also instrumental in precisely aiming the device.

The robotic delivery system integrates motion-tracking software, called the Synchrony System, with the robotics, making it accurate enough to even hit a moving target. As a patient breathes or moves slightly during treatment, the robot detects the motion and compensates in ‘real time’, ensuring that the radiation is accurately hitting the target (tumor) throughout treatment.

CyberKnife can strike the tumor with a high dose of radiation from over 1200 different angles. This pinpoint accuracy allows malignant or benign tumors to be obliterated without damaging critical healthy tissue.
 

How is CyberKnife Different ?

Standard stereotactic radiosurgery techniques rely on a rigid frame fixed to the patient's skull for head immobilization. There are other systems for extra-cranial Stereotactic Radiation. These systems are most often uncomfortable. If the target moves with the breathing of the patient, they often require breath holding techniques, which may be difficult for some patients. Frame-based systems mean there is a limit to the number of angles the radiation can be delivered through.

The CyberKnife System offers maneuverability and versatility that other systems cannot offer, therefore now making it possible to treat tumours anywhere in the body, especially the brain, spine, liver, lung, pancreas and prostate. The combination of image guidance with the help of X-ray cameras and the very latest computer technology ensures that the CyberKnife® System is able to overcome the limitations of older frame-based radiosurgery systems, such as the Gamma Knife and LINAC based X-Knife.

treatment to the tumor alone, sparing surrounding healthy tissue.

What can the CyberKnife treat?

The CyberKnife Robotic Radiosurgery System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. The treatment - which delivers high doses of radiation to tumors with extreme accuracy - offers new hope to patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option.

What is the treatment course?

CyberKnife treatment is performed on an outpatient basis. The patient receives an initial consultation with the radiation oncologist and surgeon. A CT scan (3-D X-ray) is obtained. The 3-D image obtained is used by the physicians, physicists and team to create a treatment plan.

The patient will return for the one-hour treatment within a few days after the consultation.

The number of treatments will vary depending on tumor size, location and shape, but the number of treatments is usually between one and four.

Whatare patient benefits?

• Better quality of life during and after treatment
• Head frames not used as with other stereotactic radiosurgery programs
• Performed on an outpatient basis
• Less pain
• No incisions
• Risk is minimized to healthy tissue surrounding tumor/lesions
• Fewer visits to the hospital
• Short recovery period
• Treatment is available for tumors considered inoperable by other surgery and stereotactic radiosurgery methods
• Lower risk of complications when compared to other treatment options
• Lower risk of infections
• Lower risk of hemorrhage/severe blood loss
• Lower risk of hearing loss
• Lower risk to alteration in feeling of extremities

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How colon cancers are diagnosed | Low Cost Colon Cancer Treatment in India

Diagnostic tests for colorectalcancer are usually done when:

• the symptoms of colorectal cancer are present
• the doctor suspects colorectal cancer after talking with a person about their health and completing a physical examination
• screening tests suggest a problem with the colon or rectum

Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person's family may also help the doctor to diagnose colorectal cancer. In taking a medical history, the doctor will ask questions about: a personal history of polyps in the colon or rectum inflammatory bowel disease colorectal cancer a family history of colorectal cancer familial adenomatous polyposis hereditary non-polyposis colorectal carcinoma (also known as Lynch syndrome) signs and symptoms Tumour marker tests Tumour markers are substances – usually proteins – in the blood that may indicate the presence of colorectal cancer. Tumour marker tests are used to check a person's response to cancer treatment, but they can also be used to diagnose colorectal cance Colonoscopy A colonoscopy is a procedure that lets the doctor look at the lining of the colon using a flexible tube with a light and lens on the end (an endoscope). A colonoscopy is preferred over a flexible sigmoidoscopy because the entire colon can be checked for polyps or abnormal areas. A colonoscopy is done in a hospital on an outpatient basis. The doctor gently inserts the colonoscope (a type of endoscope) through the anus and slowly moves it into the rectum and colon. The colon is inflated with air to stretch out the lining so the doctor can look at the entire surface. This can be uncomfortable, so drugs are given to help the person relax during the procedure. Biopsy During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample and may also identify the type of cancer. A biopsy is the only definite way to diagnose colorectal cancer. Biopsies of polyps or abnormal areas are taken during a sigmoidoscopy or colonoscopy. A biopsy sample will allow the doctor to find out the type of colorectal cancer and the grade. Biopsy results may also show how far the cancer has grown through the wall of the colon or rectum. Computed tomography (CT) scan A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to: check if the cancer has spread to other organs in the abdomen or pelvis (small areas of spread [microscopic spread] may not be detected by CT scan) check if the cancer has spread to the lymph nodes in the abdomen check how far the tumour has grown into the wall of the colon or, especially, the rectum CT-guided needle biopsy CT scans may also be used to help guide a needle to perform a biopsy (CT-guided needle biopsy) to check for cancer cells in a tumour in the colon or a suspected area of metastasis (cancer spread outside of the colon or rectum). Virtual colonoscopy Virtual colonoscopy uses a CT scan to create images of the colon without having to insert an endoscope through the rectum. A virtual colonoscopy is less invasive and more comfortable than a regular colonoscopy. Studies are continuing to examine the effectiveness of this test.  Ultrasound  Ultrasound uses high-frequency sound waves to make images of structures in the body. Endorectal ultrasound (EUS or ERUS) uses a special instrument (transducer) that is inserted into the rectum. It is used to see: how far a tumour has grown into the rectal wall if the tumour has spread to nearby organs or lymph nodes Abdominal ultrasound may be done to see if the cancer has spread to other organs in the abdomen, such as the liver. Pelvic ultrasound may be done if doctors suspect that the cancer has spread to the urinary tract. An ultrasound may also be used during abdominal surgery. The surgeon can place the transducer directly on the liver to check for metastases. Positron emission tomography (PET) scan A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. PET scans are not routinely used to diagnose colorectal cancer. They are more commonly used to help stage and check for recurrent disease if a person's CEA level starts to rise following treatment. PET scans are not readily available at all centres. For more information visit:          http://www.medworldindia.com                             https://www.facebook.com/medworld.india Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors. Call Us : +91-9811058159 Mail Us : care@medworldindia.com

Best Treating Options for Prostate Cancer in India : Prostate Cancer Treatment India

Knowing the various treatments for prostate cancer available and what the risks associated with each are is the first step in being informed about what will be one of the most important decisions of your life. The potential side effects of some of the treatments are too life altering to leave this decision to chance.

Have a discussion with your doctor. Ask questions about any side effects you need to be aware of. While your treatment options become less viable if your cancer has progressed beyond your prostate gland, it is important to be aware of what to expect after the treatment has been completed.

Here are some of the options open to you.

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Surgery

Surgical options available are as follows.

A complete prostatectomy where your entire prostate gland is removed     A lymph node dissection where only the nodes surrounding the urethra are removed     A transurethral resection is done in which small pieces of your prostate are removed

Each of the above procedures requires a hospital stay and you would be anesthetized and put under. They are effective in most cases although cancers have been known to return weeks or months afterward. As well, side effects can include urinary incontinence, impotence and infertility.

Radiotherapy

There are 2 common approaches to radiation therapy in treating prostate cancer, external beam radiotherapy and brachytherapy.

External beam radiotherapy is a procedure where a high energy radioactive source is used to project a beam at your prostate from a short distance outside your pelvic area. There is no anesthesia required and it is done on an out-patient basis. It is typically done on 5 consecutive days over a period of about 5 to 7 weeks.

Brachytherapy is the usage of about 100 to 150 small radioactive pellets or seeds. They are placed directly into your prostate with a syringe a few at a time; it usually takes up to 40 injections to implant them all. This procedure is painful and requires a general anesthetic.

These two procedures use radioactivity to burn away cancerous cells. Side effects include impotence, inflammation of the bladder and rectum and cancers have been known to return.

Chemotherapy

Drugs known to be toxic to cancerous cells are introduced to your body. It is used to slow cancerous growths and relieve pain. It is not a cure but it can be used to help patients where cures through other means are not possible.

High Intensity Focused Ultrasound (HIFU)

HIFU is a procedure that uses sound waves to destroy cancerous cells. A focused ultrasound beam is aimed only at the regions of the prostate that are diseased with cancer. The cells targeted are destroyed using heat. Surrounding tissue is not affected by the beam and remains undamaged.

The entire prostate can be exposed to the ultrasound beam in about three hours. The procedure is done quickly and is effective in eradicating prostate cancer in over 90% of patients treated. Side effects are minimal resulting in urinary incontinence in only 5% of patients. Only 8% suffered urethral blockage and about 40% suffered sexual impotence. Impotence drops to 20% in patients whose cancer does not affect the prostate nerve.

These reasons alone make HIFU the choice you should make when thinking about prostate cancer treatment options.

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What are the Tumors and Lesions that can be Treated by the CyberKnife System ?

What is the CyberKnife System?

The CyberKnife® Robotic Radiosurgery System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the head, spine, lung, prostate, liver and pancreas.  The treatment – which delivers beams of high dose radiation to tumors with extreme accuracy – offers new hope to patients worldwide.

Though its name may conjure images of scalpels and surgery, the CyberKnife treatment involves no cutting. In fact, the CyberKnife System is the world’s first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively.  It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery.

What can the CyberKnife System treat?

The CyberKnife® System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the head, spine, lung, prostate,  liver and pancreas.  The treatment – which delivers high doses of radiation to tumors with extreme accuracy – offers new hope to patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option. To date, more than 100,000 patients have been treated and 244 systems are installed worldwide.

Below is a list of some tumors and lesions that can be treated by the CyberKnife System:

• Osteosarcoma
• Nasopharyngeal carcinoma
• Squamous cell carcinoma
• Non-small cell lung cancer
• Small-cell lung cancer
• Pancreatic cancer
• Hepatocellular carcinoma
• Prostate cancer
• Renal cell carcinoma
• Colon cancer
• Ovarian cancer
• Uterine cancer
• Arteriovenous malformation (AVM)

The CyberKnife combines a linear accelerator, robotic arm and image guidance system. The flexibility of the robotic arm allows the CyberKnife to precisely target lesions in areas of the body unreachable by other means. The CyberKnife also is unique in its ability to continually monitor and adjust in near real-time for changes in target location during treatment. Finally, unlike most other stereotactic radiosurgery systems, the CyberKnife is able to locate and treat lesions in the head or neck without the use of an invasive head frame.

There are numerous patient benefits to the CyberKnife system, including:

• Non-invasive treatment—no head frames affixed to the skull
• No anesthesia
• No recovery time
• Surgically precise targeting (sub-millimeter clinical accuracy)
• 100% frameless
• Minimal effects to surrounding critical tissues
• Robotics adjust to compensate for patient movement
• Flexible treatment planning; image acquisition scheduled around the patient’s availability
• Complements existing St. Joseph’s radiosurgery technologies
• Treatment is typically outpatient, with just one to five treatment days required
• Suitable for treatment of many tumors or lesions throughout the body, including soft tissue, spinal, head and neck and intracranial cases
• Appropriate treatment for some patients diagnosed with inoperable or untreatable tumors or other lesions

CyberKnife radiosurgery treatment vs traditional radiation therapy treatment?

Traditional radiation therapy typically delivers radiation to a wide field of tissue in the body resulting in the treatment of both the tumor and a large amount of surrounding healthy tissue. This is necessary because traditional radiation therapy systems did not account for tumor motion and were therefore much less accurate. These wide radiation fields increased the possibility of damage to normal tissue, increasing the risk of side effects following the radiation treatment. To reduce the number of side effects, clinicians were forced to rethink the way traditional radiation therapy was delivered. As a result, the overall radiation dose was reduced and the number of treatments was divided into 30 to 40 sessions, delivered over a period of weeks.

Radiosurgery devices, such as the CyberKnife Robotic Radiosurgery System, were designed to deliver radiation with extreme accuracy, targeting the tumor with minimal damage to the surrounding healthy tissue.  The accuracy of the CyberKnife System allows clinicians to deliver very high doses of radiation safely because the size of the radiation field is smaller and only includes the tumor and a small amount of surrounding tissue.  This allows for less damage to surrounding healthy tissue and for clinicians to complete treatment in 1 to 5 days vs. the weeks it takes traditional radiation therapy.

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