Unbeatable Advantages of Robotic Prostate Cancer Surgery

A boon for Prostate Cancer patients - Advanced Robotic Prostate Surgery is now preferred choice for Prostate Cancer patients due to following Unmatched advantages

• Minimal Bleeding
• Much quicker recovery
• Reduced hospital stay
• Lesser pain killer requirements
• Lower blood transfusion rates
• Improved preservation of physical appearance
• Three (3) D vision enables surgeon to perform Prostate excision with Cancer
• Control without risk of Post Surgery Continence (control over urinary and
• fecal discharge) and causing Impotency

What is Da Vinci master slave Robotic System?

Da Vinci master slave robotic system is used to completely eradicate cancer with minimal side effects for treating Prostate Cancer. Through this system a minimally invasive robot assisted radical prostatectomy technique has been developed in which doctors evolved a unique sequence of surgical steps.

The Da Vinci is a sophisticated master-slave robot that incorporates 3-D high definition visualization, scaling of movement, and wristed instrumentation. The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is working a few feet away from the operating table, while seated at a computer console with a three-dimensional view of the operating field.

 How it is  performed ?

Robotic Prostatectomy, also known as Robotic surgery for prostate cancer or da Vinci Prostatectomy is a minimally invasive surgery that is now the preferred approach for removal of the prostate in those diagnosed with organ-confined prostate cancer. The da Vinci Prostatectomy may be the most effective, least invasive prostate surgery performed today. Though any diagnosis of cancer can be traumatic, the good news is that if your doctor recommends prostate surgery, the cancer was probably caught early. And, with da Vinci Prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been.

The operation is performed using the daVinci Surgical system and 3-D endoscopic and wristed instruments inserted through 5-6 small incisions across the mid-abdomen

UnbeatableAdvantages of Robotic Prostate Surgery over the Conventional Prostate Cancer Surgery
1) Usually in conventional approach, surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave cancer behind. In the Advanced Robotic Technique (ART) surgeons uses a sophisticated mastr slave robot that incorporates 3-D high definition vision, scaling of movement and wristed instrumentation that gives him the ability to perform Prostate excision with minimal risk of leaving the cancer behind and also minimal bleeding and post operative risk of incontinence and impotence.

2) Neither clinical nor imaging tests are sensitive enough to capture a tumour at T3 stage where it has become locally advanced and a risk for spreading to other body parts. Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence Da vinci robot system minimizes side effects thereby greater control for the patient over urinary discharge i.e. continence and return to normal sexual function after the surgery.

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The Treatment – which delivers beams of high dose radiation to tumors with extreme accuracy – offers new hope to patients worldwide.

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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Laser Prostate Surgery in India : Cost Estimate for Laser Prostate Surgery is $5000 US Dollars

Green Light PVP Surgery of Prostate in India

Thislasertreatment of the prostate is a new, minimally invasive surgical technique for treating Benign Prostatic Hyperplasia (BPH), or enlargement of the prostate. Greenlight HPS utilizes a specially designed laser light source and fiber optic delivery system developed by Laserscope in concert with researchers from the Mayo Clinic and other institutions around the world. The PVP procedure combines the immediate symptom relief and the dramatic flow rate improvements of the current "gold standard" procedure (called TURP or Trans-Urethral Resection of the Prostate) with minimal side effects, fast operative and recovery times, and usually no need for a catheter after surgery.

No other BPH treatment option has been shown to clinically provide such dramatic and immediate symptom relief while concurrently providing significant uroflow results and minimal, if any, side-effects. The PVP technique is a fast, outpatient treatment that will satisfy both the subjective (symptom relief) and objective (uroflowometry results) outcomes of a successful BPH treatment. Other minimally invasive BPH treatment options (such as TUMT, microwave, TUNA, thermotherapy) require compromises to be made by the patient and/or the physician. With PVP, there are no compromises, patient's symptoms are drastically reduced and flow rates are significantly improved.

Green Light PVPSurgery of Prostate 

The PVP (Photoselective Vaporization of the Prostate) Procedure that uses the Green Light PV laser system offers a unique and simple solution to Benign Prostatic Hypertrophy (BPH) because it combines the effectiveness of TURP, the surgical "gold standard" with the safety, comfort and ease of a minimally invasive treatment.

The PVP Procedure uses a very high powered laser to immediately vaporize and precisely remove enlarged prostate tissue. PVP (Photo-Selective Vaporization of the Prostate) is performed with the KTP laser by Laserscope (Greenlight PVP). This laser treatment of the prostate is a new, minimally invasive surgical technique for treating Benign Prostatic Hyperplasia (BPH), or enlargement of the prostate. 

Greenlight PV utilizes a specially designed laser light source and fiber optic delivery system.

The PVP procedure combines the immediate symptom relief and the dramatic flow rate improvements of the current "gold standard" procedure (called TURP or Trans-Urethral Resection of the Prostate) with minimal side effects, fast operative and recovery times, and usually no need for a catheter after surgery.

No other BPH treatment option has been shown to clinically provide such dramatic and immediate symptom relief while concurrently providing significant uroflow results and minimal, if any, side-effects. The PVP technique is a fast, outpatient treatment that will satisfy both the subjective (symptom relief) and objective (uroflowometry results) outcomes of a successful BPH treatment. Other minimally invasive BPH treatment options (such as TUMT, microwave, TUNA, thermotherapy) require compromises to be made by the patient and/or the physician. With PVP, there are no compromises, patient's symptoms are drastically reduced and flow rates are significantly improved.

The PVP procedure is performed in an outpatient setting, typically a hospital or surgical center, with average operative times normally less than 60 minutes. The GreenLight PV surgical laser system, which is used to perform the KTP laser PVP treatment, delivers laser light pulses through a specially designed fiber optic delivery device that is inserted through a standard cystoscope. The light pulses are directed towards the prostate tissue. The laser quickly vaporizes and removes the prostatic obstruction without significant bleeding.

Once the procedure is completed, patients have immediate post-operative symptom relief and dramatic improvements in symptoms, urinary flow rates, and bladder emptying.

Cost Estimate for Laser ProstateSurgery in India

Cost Estimate for Laser Prostate Surgery is $5000 US Dollars - Cost Estimate for above include stay in a Private Room for 4 days at the hospital, More accurate treatment cost estimates can be provided if medical reports are emailed to us or after the patient is examined by doctors after arrival at hospital in India and medical tests are done after admission. 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

Most Advanced Throat Cancer Treatment and Surgery in India

Throat Cancer Treatment

Throat cancer is the cancer of the throat; it is a type of head and neck cancer.  The throat (pharynx) is a 5-inch-long tube that runs from your nose to your neck. The throat and the voice box are the two main places throat cancer forms.

Throat Cancer, which is usually caused by excessive use of tobacco or alcohol, affects a person’s vocal cords, voice box (larynx), or other areas of the throat.Throat cancer can also affect the piece of cartilage (epiglottis) that acts as a lid for your windpipe.

Managing Throat Cancer

•    Find it, as early as possible

•    Confirm Diagnosis (radiology and pathology)

•    Surgery (cut it out)

•    Radiation (burn it)

•    Chemotherapy (selective poisoning)

•    Combine the above

Pre-procedure requirement

·         Different methods are used to obtain tissue for a biopsy, depending on the location of the tumor. Some of the techniques are conventional incisional biopsy, fine-needle-aspiration biopsy (FNA) and Endoscopy.

•            Imaging tests have to be done, which may include: CT or CAT scans, PET scans, MRI scans, Chest and dental X-rays.
•           Set of X-rays of the esophagus and stomach may be used to look for cancer and find out how well you swallow.
•           Laryngeal videostroboscopy is necessary that lets the doctor look at the larynx and see how well you swallow.

Strategy in Diagnosing Throat Cancer

•    Determine exact location of throat cancer lesion

•    Find out the extent of spread of throat cancer - local, regional and systemic

•    Confirm throat cancer with the diagnosis with  histo-pathological  investigation like biopsy

•    Ascertain the patient’s fitness to undergo treatment

Use a multi-modality approach if necessary to treat the disease, using:

1.           Surgical removal of the diseased part of body

2.          Loco-regional control of disease with radiation

3.          Systemic control of disease with Chemotherapy

•    Giving Patient the best quality of life possible with rehabilitation measures

•    Regular monitoring for any recurrence of disease

Tests for Throat Cancer

•    Patient’s general fitness

•    Radiological investigations for determining the extent of disease and staging

•    Biopsy is required for diagnosis

•    Performed in operation theater with patient under anesthesia

•    Other potentially required tests:

1.           Direct laryngoscopy

2.          Bronchoscopy

3.          Esophagoscopy

4.          Chest X-ray

5.          CT or MRI

6.          Liver function tests with or without US

Staging for Throat Cancer

Stae 1 and 2

Mild, usually curable.  Radiation therapy followed by surgery if necessary

Stage 3

Chances the cancer has spread are high. Radiotherapy alongside chemotherapy.  Surgery usually precedes radiotherapy, but not always.

Stage 4

Can be treated but not likely curable.  Same treatment as Stage 3. mostly palliative.

Surgery and Side Effects in Throat Cancer

Throat Cancer Treatment in India

Throat cancer refers to cancerous tumors that develop in your throat (pharynx), voice box (larynx) or tonsils. Most throat cancers are squamous cell carcinomas. This means they develop in the squamous cells that line the throat. The main risk factors for throat cancer are smoking or using smokeless tobacco and use of alcohol. Symptoms of throat cancer are trouble breathing or speaking, frequent headaches, pain or ringing in the ears, trouble swallowing and ear pain. You can reduce your risk of throat cancer by not smoking, not chewing tobacco and limiting alcohol use.

The treatment will depend on the type of cancer and how far it has spread. Minimally invasive endoscopic surgery is a new technique that removes the whole tumor through the mouth, without incisions and little or no change in speech and swallowing. 

Other procedures that can be employed are Transoral Laser Microsurgery (TLM), Transoral Robotic Surgery (TORS) and Supracricoid Partial Laryngectomy. 

Surgery for early stage throat cancer is bound to the throat surface or the vocal cords. There are surgeries to remove all or part of the voice box called Laryngectomy and Pharyngectomy to remove all or part of the throat. Surgery is the preferred treatment for early stage throat cancers. For advanced stage or recurrent throat cancer, we may combine surgery with other forms of treatment, such as radiation therapy and chemotherapy.

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HIFU in India : HIFU Ultrasound Hope for Prostate Cancer Patients

HIFU Ultrasound Hope for Prostate Cancer Patients 

Soundwaves could help 95% of prostate cancer patients … without affecting sex life,”  Its story comes from a small study that looked at an experimental treatment using high-intensity focusedultrasound (HIFU) to target areas of prostate cancer in men where the disease had not spread.

Standard treatments for prostate cancer often lead to undesirable side effects, in particular erectile dysfunction and urinary incontinence. Researchers found that a year after this experimental treatment, 89% of men still had erectile function and all were still continent. Ninety-five per cent of the men showed no evidence of disease on an MRI scan.

The results of this small study look promising. Men with early (localised) prostate cancer that has not spread can often live for years without developing life-threatening symptoms, and are often faced with a difficult decision about whether or not to have conventional treatment, which can have side effects. A treatment that can target areas of cancer without damaging healthy tissue might enable more men to have treatment for prostate cancer at an early stage.

However, it’s important to point out that this is an early “proof of concept” study and that a far larger trial is required to assess both its effectiveness and safety.This was an early (prospective development) study looking at a new treatment for localised prostate cancer called high-intensity focused ultrasound (HIFU).

Prostate cancer is the most common cancer in men, yet, as the authors point out, treating localised prostate cancer is difficult since the disease often progresses slowly and may not cause any symptoms for many years. There are several standard treatments for localised prostate cancer. Some involve treating the whole prostate with radiotherapy or removing it with surgery, and these can damage surrounding healthy tissue. The more destructive treatments of the whole prostate gland lead to undesirable side effects, in particular, erection problems (affecting 30-70% of men treated) and urinary incontinence (affecting 5-20%). One alternative for men at present is to have no active treatment but to undergo regular checks. This is known as active surveillance.

The new treatment, say the authors, is less aggressive and able to target the cancer site rather than the whole organ. In this respect, it is similar to treatment for other malignancies, such as localised breast cancer (where a lumpectomy is now an alternative to mastectomy). They say that in a previous study they had used HIFU to destroy one half of the prostate where the cancer was situated. But they point out that only one in five men have disease in one half of the prostate only. Their new study looked at whether HIFU could be used for treating cancer at specific sites within the prostate.

Advantages of HIFU Treatment :-

 • No blood loss

 • Quick recovery

 • Non surgical

 • Radiation free

 • An outpatient procedure

This is most modern technique ideal for treatment of low grade prostate cancer. It involves no surgery, no radiation , good cancer control, minimal morbidity. HIFU helps to improve the quality of life after Treatment and there are some more advantages like early return of erections and good urinary control.

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The most common cancer of a reproductive system of a woman is known as uterine cancer.

EndometrialCancer (Uterine Cancer)

Uterine (Endometrial) cancer originates in the female reproductive system and generally affects postmenopausal women between ages 50 and 60;. It develops in the body of the uterus or womb whose wall has an inner lining (called the endometrium) and an outer layer of muscle tissue (called the myometrium). 

Endometrial cancer (Uterine Cancer) is often detected at an early stage because it frequently produces vaginal bleeding between menstrual periods or after menopause. If discovered early, this slow-growing cancer is likely to be confined to the uterus. Removing the uterus surgically (Hysterectomy) successfully eliminates endometrial cancer, if detected and carried out in the initial stages. 

The most common cancer of a reproductive system of a woman is known as uterine cancer. This cancer starts in cell layers that form the lining of the uterus. This cancer can be detected in its early stage as it causes abnormal vaginal bleeding. The surgical removal of the uterus can cure uterine cancer.

Types of Uterine Cancer :- 

Sarcoma: Sarcoma cancer grows in the supporting tissues of the uterine glands or in the myometrium. This cancer accounts for 2-4% of uterine cancers.

Adenocarcinoma: This cancer is considered as the main type of uterine cancer that grows from the cells in the uterus lining. Endometrial cancer is the other name of this cancer.

The Symptoms of Uterine Cancer include :

• Unusual Vaginal Bleeding or Discharge
• Trouble Urinating
• Pelvic Pain
• Pain during sexual intercourse
• Discomfort or pain in the lower abdomen

Diagnosis of Endometrial Cancer (Uterine Cancer)

A pelvic exam is performed by the doctors checking the vagina, uterus, ovaries, bladder, and rectum for Endometrial Cancer (Uterine Cancer). An instrument called a speculum is used to widen the vagina so the doctor can see the upper portion of the vagina and the cervix.

The Pap Smear test is often performed during a pelvic exam Endometrial Cancer (Uterine Cancer). The doctor uses a wooden scraper (spatula) or small brush to collect a sample of cells from the cervix and upper vagina. The cells are then sent to a medical laboratory to be checked for abnormal changes. Because uterine cancer begins inside the uterus, it may not show up on a Pap test, which examines cells from the cervix.

A biopsy may be needed for a definitive diagnosis where the doctor removes a sample of tissue from the uterine lining. In some cases, a woman may require a dilation and curettage (D&C), which is usually a day care procedure. During a D&C, the opening of the cervix is widened and the doctor scrapes tissue from the lining of the uterus. A pathologist examines the tissue to check for cancer cells, hyperplasia, or other conditions.

Common Endometrial Cancer (Uterine Cancer) Symptoms

•   Abnormal bleeding- heavy bleeding between periods, or heavy bleeding  during irregular periods
•    Pain during intercourse, pelvic pain or pain in the legs or back
•    Difficulty urinating or pain during urination
•    Enlarged uterus , Vaginal discharge and or unexplained weight loss

Surgical Treatment of EndometrialCancer (Uterine Cancer)

Surgery is the best option when Endometrial Cancer (Uterine Cancer) is diagnosed in its very early stages. At this time, the location and the stage of cancer make removal easy. Sometimes patients are treated with a combination of surgery and radiation therapy. Laparoscopy Assisted Vaginal Hysterectomy - involves the minimally invasive or open surgery to remove the uterus. If required teh surgeon may decide to remove both ovaries and the fallopian tubes if there is a risk of Endometrial cancer spread to the ovaries.

In most cases, uterine cancer is an Adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, through the blood or the lymphatic system. In such cases advanced tratement post Hystrectomy like Chemotherapy and Radiation are advised

Chemotherapy 

Involves modern cancer drugs that are administered intravenously or orally to kill cancer cells and to reduce the chances of the tumour returning elsewhere in the body.


Radiation therapy 

India's leading Cancer hospitals now have some of the world's moset advanced radiation equipment like Linac, Novelis, Gamma Knife and Cyberknife for treating Cancers. High technology radiation is used to kill cancer cells without affecting the healthy tissues. Radiation may be used to reduce the tumor prior to surgery or to obviate the symptoms of  cancer such as pain, bleeding, or blockage.

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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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