Recovery after robotic surgery for prostate cancer – What to expect?

‘Is this a big operation?’ ‘How much time will it take for me to recover completely?’ ‘Will it be painful?’ ‘How many days will I have to stay in the hospital after the surgery?’ ‘Will I be able to climb stairs after I am discharged?’ ‘When can I drive? Go for a walk….?’

These are some very practical questions that I am asked almost everyday during my initial counselNurse at Patient Cart da Vinci Siling sessions with gentlemen who have been diagnosed with prostate cancer and are considering robotic prostatectomy (robotic surgery for prostate cancer). Fortunately, the answers to these common questions are almost always better than what they expect to hear!

Robotic surgery has had such a positive impact on postoperative recovery that it is sometimes hard to believe that it still is ….and will always remain…. a major cancer operation.

When I talk to my patients about this, I just tell them the sequence of events that they are likely to go through before, during and after the surgery. I tell them that there is a 95% chance that they will be able to stick to this pathway. Roughly, a 5% chance does exist, for having some problems or complications during the recovery phase. However, the vast majority of these can be managed effectively, albeit, with extra medications or procedures and hospital stay.

What follows is a step by step description of what to expect after robotic surgery for prostate cancer:

Step 1: Admission

You will be admitted to the hospital the evening prior to the date of surgery. In some circumstances you may be asked to come in the same day early in the morning. Before admission, all the relevant investigations are reviewed and a clearance for surgery is taken from the anesthesiologists. This is called the pre-anesthesia check up or PAC. At this time, if necessary, further advice and clearance may be sought from other specialists like cardiology, endocrinology etc. This is to ensure that all potential risk factors are assessed and mitigated prior to the surgery. This is done with the sole intention of keeping you safe during and after surgery. The night before the surgery you will be provided a normal dinner and some medications to help you have a relaxing sleep before the day of the surgery. You will be asked not to eat or drink anything after midnight and will be requested to sign the consent form for the operation.

Step 2: The operation

You will be moved to the preoperative holding area about an hour prior to the time of surgery. Here you will receive antibiotics to decrease chances of infection and will be reviewed by anesthesiologists. You will then be moved to the main operating room and anesthesia will be administered. Robotic prostate cancer surgery, on an average, takes about 3-4 hours to complete.

Step 3: After the surgery (Postop day 0)

After surgery, your surgeon will meet your next of kin and provide them with information about your surgery and expected recovery. You will be able to meet your loved ones in the post operative recovery room after 1 or 2 hours when you have recovered from the effects of anesthesia. Thereafter, you will be moved to your room. You will be able to have a full liquid diet starting 4 hours after the completion of your operation, although some fluids will also be given intravenously for support. You will be encouraged to move all your limbs and do deep breathing exercises. You would be expected to be reasonably comfortable with the help of painkillers that would be administered to you. At this time you would have a urinary tube and a thin abdominal drain to remove fluids from the body.

Step 4: The day after surgery (Postop day 1)

On the day after the operation, you will be served a normal diet for breakfast and intravenous fluids will be discontinued. You will be encouraged to walk about outside your room for a total of 60 minutes during the day, in splits of about 10 minutes each. The abdominal drain will be removed and medications tapered down. Deep breathing exercises (incentive spirometry) and steam inhalation are very important components of your ‘home work’ on this day. This keeps your lungs healthy and prevents infection. You should be quite comfortable with the help of medications.

Step 5: The next day (Postop day 2)

This is the day you go home! You will be relatively pain free such that you can manage easily on oral medications, without the need for any injections. Your confidence in moving about and doing all your daily activities should be back. You can take regular meals, travel in a car, go for a walk and climb stairs. You can also take a shower on this day. You will be discharged with clear instructions on how to manage the urinary tube, which would be removed after 1 week. You will be prescribed some medications to ease your visit to the washroom and to keep you comfortable. Although you would likely have passed some wind by now, passage of stools may take another day or two in the course of a normal recovery.

Step 6: A week later 

You will be asked to come into the hospital and stay there for 3 – 4 hours in the daycare ward. Here your urinary tube (catheter) will be removed. You will be taught pelvic floor exercises (Kegel exercises) to promote early recovery of full urinary control. You will be advised on the proper use of continence pads, water intake etc. and sent home on the same day after you have comfortably passed urine a few times. If the pathology (biopsy) report from the surgery is available by that day, your doctor will discuss the findings with you. After this time, you should be well on your way to a full recovery. You can rejoin your work in about 2 -3 weeks. Most men are comfortable enough to start driving around the same time.

Step 7: A month later 

You will likely have fully recovered by now, except that you may be needing a couple of pads to control leakage. Even this is likely to rapidly improve in the coming few weeks. You should get your first PSA test 1 month after the day of your surgery. This will give you and your doctor an excellent idea about the control of the disease and the chances of requiring further treatment, if any. You will need to be in regular follow up with your doctor to ensure that you remain trouble free. Initially it will be once every 3 months. As the years go by, you are likely to require a visit to the clinic only once in a year.

I hope that you found this blog useful. I wish you a speedy recovery!

 

Dr. Gagan Gautam is the head of robotic surgery for prostate, kidney and urinary bladder cancer at Max Institute of Cancer Care, New Delhi, India. Besides being one of the leading specialists for prostate cancer in India, he is also an expert in nerve sparing robotic prostate cancer surgery, which has been shown to result in a faster recovery of urinary control and potency after prostate operation. To know more about him, please click here or visit his website http://www.roboticsurgerydelhi.com.

To read a patient’s first hand account on the experience of undergoing robotic prostate surgery, please click here.

To contact Dr. Gautam or to seek an appointment, please click here.

To view his video on robotic prostate cancer surgery, please click here.

To read his blog on the cost of prostate cancer treatment in India, please click here.

To read his blog on robotic prostatectomy, please click here.

To read his blog on watchful waiting and active surveillance for prostate cancer, please click here. 

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Kidney cancer treatment in India – Patient feedback

A diagnosis of kidney cancer does not mean that your are at the end of the road. There are innumerable stories of courage, innovation and determination that can inspire us. Fortunately, with modern technology and treatment techniques, there is hope for the vast majority of people who would not have been treated effectively till just a few years back.

One such story, is that of a surgical colleague of mine, a plastic surgeon in Iraq, who had came over with his father to me a few months ago. What follows is an extract from his post on http://www.facebook.com/roboticsurgerydelhi. You can read his post through a link at the end of this blog.

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There is always light at the end of the tunnel….recovering well after surgery…..

“Everyone may face a hard time, and during that, you have to know who will be there with you to pass it.
My father Safaa Alhassany is 67 year old with past medical history of angina, hypertension, gout and DM. We discovered accidentally that he had a big tumour in the middle lobe of his left kidney and to make it complicated, the right one was shrinkage and with only 12% function!! Which meant a real ((disaster))!!
After a lot of consultations there in my country and here in India, there was no doubt that we are going to the dark side of our life..
There was no choice other than nephrectomy due to the size and site of the tumour.
Thanks Godness, following someone’s recommendation, I met Dr. Gagan Gautam and he was the only one offers a partial nephrectomy to save the kidney and get rid of the mass. Within a week time, he bravely took the plunge and operated on my dad and thankfully did it, saving about a half of the kidney after a super-major, long and difficult operation lasted more than 5 hours.After a month of this nightmare, I write my story just to say thank you to the one who saved our family Dr. Gagan Gautam and to let the others know that the hope is usually there but you have look for it carefully.
A big thank you to Dr. Gagan Gautam and his team.”

Dr. Hussein safaa

https://www.facebook.com/roboticsurgerydelhi/posts/632210403526822

Dr. Gagan Gautam is the Head of Urologic Oncology & Robotic Surgery at Max Institute of Cancer Care, New Delhi, India. He is India’s leading expert in robotic surgery for prostate, kidney and urinary bladder cancer treatment. To know more about him, click here, or visit his website http://www.roboticsurgerydelhi.com.

To read Dr. Gautam’s blog on robotic surgery for kidney cancer, please click here.

Urinary bladder cancer treatment in India – choosing the right options

Imagine this. Everything is coming along fine in your life until you visit the washroom one day and suddenly discover that there is blood in urine. You feel no pain, no weakness, no fever. More likely than not, you ignore this – try to pass it off as a mild ‘infection’ and get on with your life. Until, after a few weeks, it happens again; And again. You visit your neighborhood physician who orders a few tests and an ultrasound exam. When the results come in you are shocked to discover that you have a mass in the urinary bladder, which is highly likely to be cancer.

Unfortunately, this is a common sequence of events for almost half a million people worldwide who are diagnosed to have urinary bladder cancer every year. The biggest impediment to effective and complete cure for bladder cancer is delay in diagnosis. The initial symptoms are all too often ignored by patients and doctors alike, while a curable cancer inexorably grows and spreads unnoticed to become life threatening. Bleeding in urine is a dangerous symptom and must not be ignored!

Smoking is the most common cause of urinary bladder cancer with about 50% of these tumors attributable to this single cause. Other causes – mostly unknown – account for the other half, and include exposure to certain chemicals and chronic infections of the bladder. Smoking is also a very important cause of recurrence of this disease in those who have already received treatment for urinary bladder cancer. Kicking the habit is essential to decrease the chances of bladder cancer coming back after initial treatment.

Urinary bladder cancer treatment in India is now quite standardized. Once a growth in the urinary bladder seen on ultrasound, the next step is to do a ‘cystoscopy’ which involves putting a thin telescope through the urinary passage into the urinary bladder under anesthesia. The tumor is visualized with a camera and is cut out and removed with specialized instruments. This procedure is called transurethral resection of bladder tumor (TURBT). This procedure not only removes the tumor but also provides vital information about the type (grade) and degree of spread (stage) of the cancer.

Depending upon the microscopic features of the tumor, bladder cancer can be either low grade (less aggressive) or high grade (more aggressive). This has important implications on further treatment. In terms of staging, it is vital to assess whether the bladder cancer is ‘superficial’, involving only the superficial (innermost) layers of the bladder or ‘muscle invasive’, which implies an infiltration of the cancer into the deep muscle layer of the urinary bladder.

For ‘superficial’ bladder cancer, the standard treatment involves regular follow up with repeated ‘cystoscopy’ examinations and the use of medications instilled directly into the bladder through the urinary passage at regular intervals. For ‘muscle invasive’ bladder tumors, the most effective treatment is to perform major surgery to remove the urinary bladder completely (radical cystectomy) and create a new bladder or tube using segments of intestine (urinary diversion, orthotopic neobladder or ileal conduit). While this has traditionally been performed via open surgery, urinary bladder cancer treatment in India is now getting revolutionized with the advent of robotic surgery.

Robotic surgery for bladder cancer offers a faster recovery, lesser blood loss, lesser pain and a possibility of a lower complication rate. Cancer control and cure rates are similar to open surgery.

In summary, smoking is the most common cause of urinary bladder cancer and blood in urine, its most common symptom. After initial removal via TURBT, subsequent treatment depends on the grade and stage of the disease. If required in a particular situation, robotic surgery for bladder cancer can improve outcomes and may be the next big revolution in urinary bladder cancer treatment in India.

This blog has been written by Dr. Gagan Gautam, Head of Urologic Oncology & Robotic surgery at Max Institute of Cancer Care, New Delhi, India. Dr. Gautam is a specialist doctor for prostate, kidney and urinary bladder cancer treatment in India and is the country’s leading expert in robotic surgery for these diseases. Max Institute of Cancer Care, a part of Max hospitals, Saket, New Delhi is a tertiary referral center regarded by many as the best hospital for bladder cancer treatment in India. It is equipped with state of the art facilities for radiation, chemotherapy and surgery for bladder cancer – including the Da Vinci Xi HD robotic surgical system. It is situated 20 minutes away from New Delhi’s international airport.

 To know more about, Dr. Gautam, please click here or visit his website www.roboticsurgerydelhi.com

 To connect with him on social media, please visit www.facebook.com/roboticsurgerydelhi or follow him on twitter @DrGaganGautam

 To seek an appointment or to get in touch with him, please click here

Robotic surgery is revolutionizing kidney cancer treatment in India

Hi tech robots performing complex operations on human beings through miniaturised instruments may sound like the stuff science fiction is made of …but it may be closer than you think. In fact, it is already here!

Robotic surgery has now entered the second decade since its inception around the turn of the century, and is now all set to revolutionise the way complex surgeries are performed. There are over 2000 surgical robots in the world today (>1500 in the US, ~ 20 in India) and they are increasingly being employed for the surgical treatment of cancers in India and abroad.

The most advanced robotic surgical system in the world today is the Da Vinci system developed by Intuitive Surgical (Sunnyvale, California, USA). It comprises of a console, patient side robotic machine and another cart, which houses the display monitor and lighting equipment. The surgeon sits at the console and through futuristic “master controls” initiates and controls the movements of robotic arms, which translate the movements of the surgeon to the robotic instruments inside the patient’s body. This system affords extremely precise and delicate movements made possible by the extreme miniaturization and flexibility of these special robotic instruments. Surgeon tremor is completely eliminated and the movements can be scaled (3:1) for greater finesse. Accompanying these advances in instrumentation, is the superb high definition magnified 3D vision of the operative field that the surgeon gets while sitting at the console of this robotic system. This enables the surgeon to see and appreciate minute structures inside the human body thereby making surgery potentially safer and more complete – aspects, which can be vital to a cancer patient.

Surgery for prostate cancer (robotic prostatectomy) is by far the most common cancer operation performed with robotic systems in the world today. Another condition in which the application of robotics is being considered a big step forward is – kidney cancer. Although relatively rare, kidney cancer is unique in being almost 100% curable if detected at an early stage when it is confined to the kidney and almost 100% fatal if it is detected at a stage when it has spread to other parts of the body. Kidney cancer treatment success rate is very high at early stage of the disease and very dismal at a late stage. Moreover, radiation and chemotherapy have been shown to be quite ineffective in this disease thereby leaving surgery as the only effective treatment option.

Surgery for kidney cancer broadly encompasses two separate types of operations – radical nephrectomy, in which the entire kidney is removed along with the tumor; and partial nephrectomy, which entails the selective removal of the cancerous portion of the kidney while sparing the rest of the kidney. Radical nephrectomy may be necessary in situations where the size of the tumor is large (typically more than 7 cm in greatest dimension) or when the location of the tumor makes it impossible to remove the tumor safely and completely without removing the entire kidney (as in the case of a tumor situated very close to the main blood vessels of the kidney). The removal of the entire kidney however, comes at a cost. The decrease in overall kidney function causes an adverse impact on the cardiovascular system and increases manifold, the chances of life-threatening complications later in life, such as heart attack and stroke. Moreover, in the long term, the chances of kidney failure and dependence on dialysis also increase significantly.

While radical nephrectomy may be inevitable in certain situations, most of the smaller and early stage tumors can be dealt with by the removal of the tumor itself while leaving the rest of the normal kidney behind (partial nephrectomy). In fact, it is universally acknowledged by all major cancer guidelines and medical associations that a partial nephrectomy achieves equal cancer cure for smaller tumors (<7 cm) as compared to a radical nephrectomy. At the same time, it enables the preservation of the maximum amount of normal kidney tissue and decreases the chances of heart attacks, strokes and dependence on dialysis. So overall, patients with small tumors in the kidney are likely to live longer, healthier lives if they choose to undergo partial nephrectomy rather than a complete removal of the kidney.

Though there are a number of ways of doing a partial nephrectomy (open, laparoscopic and robotic), robotic surgery has recently completely transformed the landscape in this type of kidney cancer treatment. In a number of major cancer centers in the western world, robotic surgery is now being used to perform over 90% of the total partial nephrectomy surgeries performed. Robotic surgery is also being increasingly used for kidney cancer treatment in India. The advantages of robotics in this operation are clear – excellent vision and dexterous fine instruments enable precise removal of the tumor and reconstruction of the remaining kidney with superior results and decreased complications. Since the operation is performed through small “keyhole” cuts without the need of a big open incision, the patient recovers faster, has less pain and is able to become fully active much earlier than conventional open kidney cancer surgery. Moreover, blood loss during the operation is significantly reduced and over 95% of patients do not require any blood transfusion thereby decreasing the transmission of blood borne infections.

The technology however doesn’t come cheap. The purchase and maintenance of the robot carries a cost, which invariably finds its way into the patients’ hospital bills. Using the robot inflates the cost of kidney cancer treatment in India by about 30% but some of this increased cost gets offset by the early discharge and less medications required after the operation. The chances of requiring readmission to the hospital also decreases, thereby decreasing the overall cost of kidney cancer treatment.

As the awareness regarding robotic surgery spreads in the country and as more and more robotic systems are installed in the top cancer hospitals in India, it is inevitable that an increasing number and types of procedures will be performed with the help of this technology. Already the robot is being used in a variety of different surgical specialties including gynecology, head and neck surgery and cardiac/thoracic surgery. This is only going to increase in the future. All this should translate into a significant improvement in the surgical care that is currently available at our medical institutions and enable surgeons to provide a relatively pain free, safe and effective solution for a gamut of diseases.

There is however, one important caveat that must be borne in mind prior to undergoing robotic surgery. Like any new technology, robotic surgery has a definite learning curve and requires specific training and experience in this modality. It may take up to 200 cases for a surgeon to become proficient in robotic surgery and become comfortable with this interface, which is completely different from open and conventional laparoscopic (“keyhole”) surgery. Although the technology is superlative, it is the man behind the machine that delivers the results.

This blog has been written by Dr. Gagan Gautam, head of urological cancer surgery and robotic surgery at Max Institute of Cancer Care, New Delhi, India. Dr. Gautam is the leading specialist for prostate, urinary bladder and kidney cancer treatment in India and is an expert in robotic surgery for these conditions. His institution is an 800 bed referral center recognised as one of the best hospitals for cancer treatment in India. It is equipped with state of art technological equipment including the Da Vinci Xi HD robotic system which is used by Dr. Gautam to advance the role of robotic surgery for the treatment of kidney cancer in India.

To know more about Dr. Gagan Gautam, please click here

To read a patient’s personal experience after kidney cancer surgery, please click here

If you would like to seek an appointment or would like to get in touch with him, please click here

To connect with him on social media, please visit facebook.com/roboticsurgerydelhi or follow him on twitter @DrGaganGautam

To visit his website, please go to http://www.roboticsurgerydelhi.com  

Watchful waiting and Active surveillance for prostate cancer

Contrary to what a lot of people believe, prostate cancer treatment options do not start and end with surgery, radiation or hormone therapy. There are two other treatment options for prostate cancer that need to be discussed and evaluated in almost every newly diagnosed gentleman with this disease. And these are – Watchful waiting and Active surveillance.

Watchful waiting implies withholding active treatment for prostate cancer (surgery, radiation or hormone therapy) in men with advanced age or multiple medical problems till they develop significant symptoms from the disease. It is considered in men with early prostate cancer, who have a limited life expectancy of less than 5 to 10 years and have not yet developed significant symptoms from their disease. It is based on the premise that a significant proportion of men with prostate cancer have slow growing disease and hence will not be affected by it in their expected lifetime. It is very important to note that AGE should not be the sole criterion for applying watchful waiting in patients. I have come across many patients even in their late 70s who enjoy excellent health and have a life expectancy of at least 10 to 15 years and more. These are the patients who are very likely to benefit from active treatment for prostate cancer with surgery or radiation.

Active surveillance, on the other hand, is a treatment option for very early stage of prostate cancer which is expected to be localised within the prostate and has not spread beyond it. It can be applied to men with less aggressive types of this disease and can be recommended as an alternative to immediate treatment with radiation or surgery. For active surveillance to be considered, ALL of the following conditions should me met in the evaluation of the patient:

  • PSA should be less than 10 ng/ml
  • Gleason score in the biopsy should be 3+3 = 6; Men with Gleason 7 or above prostate cancer are not good candidates for active surveillance in most circumstances
  • In the biopsy report, not more than 2 cores should be positive for prostate cancer
  • There should not be an involvement of more than 50% of any core with prostate cancer
  • Clinical stage should be T2a or less (This is determined by your doctor on physical examination of the prostate)

If all the above criteria are met, a serious thought should be given to proceeding with active surveillance and withholding immediate treatment for prostate cancer. Active surveillance involves regular physical examination and PSA tests every 3 months, and a prostate biopsy repeated every year to ensure that the cancer is not becoming more aggressive. In case it is found that the cancer is increasing in volume or aggressiveness, immediate treatment is indicated. It has been found that by following this strategy, up to 70% of patients fulfilling the above criteria can safely avoid surgery, radiation or hormone therapy for prolonged periods of time with attendant benefits in terms of improved quality of life and decreased complications.

In summary, it is important to have a discussion with your doctor about all the treatment options for prostate cancer including active surveillance and watchful waiting. It is also a good idea to seek a second opinion from another source to increase your knowledge and reach an appropriate decision for individualizing treatment for prostate cancer depending on the person’s medical conditions, disease status and preferences.

This article has been written by Dr. Gagan Gautam, Head of Urologic Oncology & Robotic Surgery at Max Institute of Cancer Care, New Delhi, India. Besides being India’s leading robotic surgery expert  for prostate cancer, Dr. Gautam is also closely involved in the counselling and individualised care of men afflicted with this disease. His major focus is directed towards helping men in selecting and receiving the best treatment option for prostate cancer based on their personal medical conditions and preferences.

View Dr. Gautam’s profile here

If you are seeking an appointment, please click here

To read about robotic surgery for prostate cancer, please click here

To read about recovery after robotic surgery, please click here

To read a patient’s first hand account on the experience of undergoing robotic prostate surgery, please click here

To see a video of robotic surgery for prostate cancer, please click here

To read about the cost of prostate cancer treatment in India, please click here  

Cost of prostate cancer treatment in India

Being told by a doctor that you have been diagnosed with prostate cancer is probably one of the most traumatic experiences that anyone can have. The road ahead becomes uncertain and every step seems tricky and arduous. There is little doubt that prostate cancer extracts a psychological cost from the person it afflicts and also from his near and dear ones. This impact can be lessened by a compassionate and confident healthcare provider and perhaps more so, by caring and understanding family members.

The next step ideally involves an informative exchange of information amongst all stakeholders to ascertain a coherent plan of treatment. One of the major realities that one has to face in this situation is the cost of prostate cancer treatment, specially since this financial burden is often unexpected and unplanned for in a country like India, where the vast majority of population does not have medical insurance. What follows are a few important pieces of information about the expected cost of prostate cancer treatment in India, which fortunately, is still way below that seen in most parts of the world.

I shall be covering three established prostate cancer treatment options – Surgery, Radiation therapy and Hormone therapy. Other treatment options like HIFU, Cryotherapy and Cyberknife cannot be routinely recommended for the treatment of prostate cancer in India currently, since they are in an early phase of adoption with little information available about their long term outcomes and complications. Moreover, the discussion on how to choose the right treatment for prostate cancer is beyond the scope of this blog and will be addressed in another post.

Hormone therapy: Hormone therapy or Androgen Deprivation Therapy (ADT) as it is called in medical terminology implies the use of injections to suppress the level of Testosterone (male hormone) in the body to near – zero levels. This acts to decrease the growth and spread of prostate cancer for a duration of time ranging from a few months to a few years. While it is the mainstay of treatment for prostate cancer which has spread to other parts of the body (stage 4 or metastatic cancer), it is NOT recommended as the ONLY treatment for most cases of prostate cancer which is limited to the prostate region (localized prostate cancer) since it does not cure the disease but only controls it for some time. Invariably, with time the cancer starts becoming resistant to hormone therapy and starts spreading after that. The cost of hormone therapy ranges from 16,000 – 30,000 INR for an injection, which is to be given every 3 months. Some of the brands available in India are Zoladex®, Lucrin®, Eligard® and Pamorelin®.

Important points to discuss with your doctor:

  • A more expensive injection is not necessarily more effective. One should go for a cheaper, yet trusted brand to ensure that adequate effectiveness is achieved without excessive financial burden.
  • An injection imported from outside India is not necessarily more effective than an indigenous version.
  • You can often get these injections at up to 20% less than the MRP if you directly purchase it from the company representative. Your doctor should be able to provide you with the contact details.
  • Be careful about the storage requirements of the injection. Some of these require to be kept refrigerated during transportation and storage to maintain effectiveness.
  • A longer acting version (6 months) may be a cheaper option than two 3 monthly injections.
  • Removal of testes (surgical castration or bilateral orchidectomy) is a less expensive alternative to injections in the long run but is associated with an adverse psychological impact due to changes related to body image.

Radiation therapy: Radiation treatment is an alternative to surgery in patients who have prostate cancer that is localized to the area of the prostate and has not spread to other parts of the body. In most circumstances, radiation therapy needs to be combined with hormone therapy for 2 to 3 years in order for it to come close to the effectiveness and cure rates of surgery alone. Image Guided Radiation Therapy (IGRT) is currently the standard benchmark for the radiation treatment of prostate cancer in India. It is delivered over 6 to 8 weeks with 5 daily sessions in a week. The cost ranges from 2.0 – 2.5 lacs (200,000 to 250,000 INR) in most private institutions in the country with advanced radiation facilities. The addition of hormone therapy to this treatment increases the cost by about 65,000 to 1,20,000 INR per year bringing the total cost of treatment to about 4.0 to 6.0 lacs (400,000 – 600,000 INR), albeit spread over 2 to 3 years.

Brachytherapy, which is a form of radiation for early prostate cancer, involves the placement of radioactive ‘seeds’ in the prostate under the guidance of an ultrasound machine. These seeds need to be imported from abroad and the treatment can cost anywhere from 5.0 – 8.0 lacs (500,000 – 800,000 INR) depending on the number of seeds required and the prevailing currency exchange rate. It is one of the more expensive options for treatment, especially if it is combined with hormone therapy.

Surgery: The complete removal of the prostate, along with the adjoining structures (seminal vesicles, lymph nodes etc.) done with an intention to cure a patient of prostate cancer is called Radical prostatectomy. It can be performed in an open conventional manner or with laparoscopy or robotic surgery. Robotic surgery for prostate cancer is now available in the country and is currently considered by many to be the best treatment for prostate cancer in India. It has the advantages of a faster recovery, greater precision and lesser complications as compared to conventional surgery for prostate cancer. The cost of robotic prostate cancer surgery in India is usually in the range of 3.5 to 4.0 lacs (350,000 – 400,000). While this cost is about 30% more than that of conventional surgery, some of this gets offset by the earlier discharge from hospital, less medication use and decreased chances of additional treatment due to decreased complication rates with robotic surgery.

In summary, while the ideal treatment for prostate cancer in a particular patient differs from individual to individual based on their age, overall health status and stage of the disease, cost considerations do play a major role in the decision making process. All these implications should be discussed with your doctor in order to arrive at the most suitable decision.

This article has been written by Dr. Gagan Gautam, who is the head of urological cancer surgery and robotic surgery at Max Institute of Cancer Care, New Delhi, India. He is fellowship trained in robotic cancer surgery from the University of Chicago Medical Center, USA and is currently the leading robotic surgeon for prostate, kidney and bladder cancer in India. His institution, Max Hospitals, Saket, New Delhi is an 800 bedded tertiary hospital located just 20 min away from the International airport. It is an NABH accredited institution and is recognised as one of the best hospitals for prostate cancer treatment in India. It is equipped with state of the art diagnostic and therapeutic infrastructure including the Da Vinci Xi HD robotic surgical system, which is used by Dr. Gautam to perform robotic surgery on his patients who travel from all over India and other parts of the world.   

 To know more about his work, please visit www.roboticsurgerydelhi.com

To view Dr. Gautam’s profile, please click here

 If you would like to submit a query or seek an appointment with Dr. Gautam, please click here

 To know more about robotic surgery for prostate cancer, please click here

 To watch a video demonstration of robotic prostate cancer surgery, please click here

To read about the expected course of recovery after robotic surgery, please click here

To read a patient’s first hand account on the experience of undergoing robotic prostate surgery, please click here

To read about active surveillance and watchful waiting for prostate cancer, please click here

Robotic surgery for prostate cancer in India – A video demonstration

Dr Gagan Gautam, head of robotic surgery and urologic cancer surgery at Max Institute of Cancer Care, New Delhi, India, demonstrates the tips and tricks of robotic surgery for prostate cancer. A systematic and simplified approach decreases complications and enhances the recovery after robotic surgery for prostate cancer. By reducing the duration of surgery and stay in the hospital, it also serves to decrease the cost of prostate cancer treatment in India which offsets the cost of robotic surgery to a large extent.

Max Hospital, Saket is one of the best hospitals for prostate cancer treatment in India and provides specialist services for the treatment for all stages of prostate cancer. Robotic surgery for prostate cancer is a state of the art technique which improves recovery, decreases complications and provides excellent survival benefits to patients with stages 1 to 3 prostate cancer.

To know more about his work, please visit http://www.roboticsurgerydelhi.com

To view Dr. Gautam’s profile, please click here

If you would like to seek an appointment with Dr. Gautam, please click here

To know more about robotic prostate cancer surgery at Max Hospital, New Delhi, please click here

To read about the expected recovery after this surgery, please click here.

To read a patient’s first hand account on the experience of undergoing robotic prostate surgery, please click here

To read about the cost of prostate cancer treatment in India, please click here

To read about active surveillance and watchful waiting for prostate cancer, please click here