Prostate cancer treatment in India – A personal experience..

Making a decision regarding the best treatment option for prostate cancer is a difficult task. Every individual with this disease is unique and the ideal treatment for one may not be so for another. However, it does help to learn about other people’s experiences so that one can get to know the expected outcomes of treatment by any particular technique or technology…

Here is a real life account of a gentleman who underwent robotic surgery for prostate cancer in my care. I am grateful to his daughter (who has penned this down) for sharing the intricacies of the decision making process…something that will strike a chord with so many gentlemen and their loved ones who happen to be in the same situation as this family was just a few months ago…

Posting real life experience of my father, a Prostate Cancer patient who under went RARP under the able hands of Dr. Gagan. [Posting from my Dad’s account]

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“Cancer” the word itself strikes fear. We hear it happening all around and somehow think we and our near and dear ones are impervious to it.

….and then it hits you or a family member out of nowhere. In our case my father who had just turned 60 few months back was diagnosed with Prostate Cancer in Jan 2014. No symptoms, no health issues just underwent routine health checkup and he was diagnosed with elevated PSA of 24. A rectal biopsy followed which confirmed the cancer with a Gleason Score of 3+4.

Our search for a doctor along with state of art medical facilities led us to Dr. Gagan Gautam at Medanta. At the time we were evaluating Surgery vs. Cyberknife (a focused radiation based approach where prostrate is not removed). We first fixed an appointment with Dr. Gautam and four of us literally spent close to 2 hours with him asking him questions and discussing the whole thing. The patience, grace and humbleness with which he attended to us and assuaged all our fears was really amazing. My Father (actually the whole family) was completely sold on the idea that he should be our doctor and that if surgery is to be done then he is the doctor who should do it.

We shelved our Cyberknife plans and decided to undergo simple and effective RARP surgery through Dr. Gagan. On the appointed day my Dad was taken in for surgery around 7 am and was wheeled back to his room by 3:30 pm. We spent a total of 3 nights in hospital and were home just around lunch time on day 4. My dad had his catheter removed in exactly a week’s time. His first month PSA was less than .02 which indicated the disease was controlled via the operation. 3 months down the road he does not use pads; his urine control is good, enjoys playing with his grandson and drives himself 25km one way to his work. I don’t think we could have asked for anything more. All thanks to Dr. Gagan Gautam.

PS: 
We decided on RARP because it was the latest treatment, less painful (only 5 holes ), has been in practice for close to a decade, recovery after surgery was fastest and chances of my dad having normal life like before were the best. Plus we did not want to keep the infected organ inside the body considering the age of my father, hence Cyberknife was a ruled out.

Cancer is a complicated disease and my father did have some lymph node spread as shown by the final biopsy which is done on the removed organ and tissue, thankfully the margins were clear. Also, the staging of cancer tends to change what started as 3+4 Gleason score for us was finally a 4 +4 after the final biopsy (cancer staging changed as well). In course of cancer treatment there will be good days, bad days and even more bad days, I think best we can do is to keep having faith and positivity. After God’s will, I attribute my Dad getting well to not only a highly skilled doctor, but also his own resolve and will to get better.

Good Luck!

To read the original post, please visit http://www.facebook.com/roboticsurgerydelhi/posts/635216833226179

Dr. Gagan Gautam is the head of robotic surgery and urologic oncology at Max Institute of Cancer Care, New Delhi, India. He is India’s leading expert in robotic surgery for prostate cancer and is closely involved in the counselling and management of patients with this disease. To know more about him, please click here or visit his website, http://www.roboticsurgerydelhi.com

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

To read his other blogs on prostate cancer treatment please click on the links below:

What is the best prostate cancer treatment in India?

Robotic surgery for prostate cancer in India – A video demonstration

Cost of prostate cancer treatment in India

Watchful waiting and active surveillance for prostate cancer

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

 

 

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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. 

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

What is the best prostate cancer treatment in India?

Prostate cancer is the most common cancer affecting men all over the world and can cause a significant loss of quality and quantity of life in men affected by this disease. However, if detected at an early stage it can also be completely cured or controlled for a very long time with modern treatment methods available today. Max Institute of Cancer Care (a part of Max Hospitals, Saket) is an advanced tertiary care medical center in New Delhi, India with state of the art facilities for the diagnosis and treatment of prostate cancer.

The Disease

For a proper plan of treatment to be implemented, it is imperative to diagnose and stage the disease. The diagnosis is achieved by a prostate biopsy performed in response to either an abnormal PSA (prostate specific antigen) test and/or an abnormal physical examination of the prostate. Gleason score is a system devised by pathologists to quantify the aggressiveness of prostate cancer on the basis of how it looks under a microscope, after the biopsy specimen is made into a slide. As the Gleason score increases, prostate cancer becomes more aggressive.

Staging comes next. Staging involves an assessment of how far prostate cancer has spread from the prostate. If the disease is confined to the prostate itself, it is said to be localized. If it has gone outside the prostate but has not spread to the rest of the body, it is locally advanced and if it has spread to other parts of the body, it is said to be metastatic. An assessment of the spread of disease can be made by performing 2 tests – MRI of the prostate region and an MDP Bone scan.

The Operation

Robotic prostate cancer surgery (Robotic prostatectomy) is the most advanced treatment and in most circumstances, the best prostate cancer treatment in India (and in the world) today. For localized prostate cancer, it offers a very high cure rate with minimal long-term side effects. Even for locally advanced disease, it provides excellent long-term control/cure when used as the initial main step in a multi modality treatment approach with radiation and/or hormone therapy.

The main advantages of a robotic prostate cancer surgery are greater precision, faster recovery, lesser blood loss, less pain and better preservation of urinary control and sexual function as compared to conventional treatment. 95% of patients are able to leave the hospital within 24-48 hours after surgery and are fit for travel within 1 – 2 weeks.

The cost of prostate cancer treatment in India with robotic surgery is 3.5 to 4.0 lacs INR, approximately. For overseas patients, it works out to be approximately $8500 (US).  This includes cost of stay, all medicines, surgery charges, basic investigations and equipment used for the surgery. Additional investigations or treatment may incur extra charges but are usually not required.

The Surgeon

Dr. Gagan Gautam is the head of urologic cancer surgery and robotic surgery at Max Institute of Cancer Care, Saket, New Delhi. He is a US fellowship trained robotic urological cancer surgeon and his entire practice is exclusive to the surgical care of patients suffering from prostate, kidney and urinary bladder cancer. He has an extensive experience of working in top national and international hospitals including the University of Chicago Medical Center, Chicago, USA, considered as one of the most advanced centers for robotic cancer surgery in the world today.

Dr. Gautam is the leading robotic urological cancer surgeon in the country and has pioneered several advanced procedures for the treatment of prostate cancer in India . His endeavours are focussed towards providing his patients the most advanced and cost effective robotic surgery procedures available only at leading international institutions. 

The Hospital

Max Institute of Cancer Care at Saket, New Delhi is a part of an 800 bed state of the art tertiary care medical center situated just 20 minutes away from New Delhi’s Indira Gandhi International Airport. It is the hub of medical tourism in the region with many national and international patients undergoing complex surgical treatments here at any point of time. It is in the process of being accredited by Joint Commission International  (JCI) for its high standards of patient care and safety and is recognised as one of the best hospitals for cancer treatment in India. The hospital is equipped with the most advanced diagnostic and therapeutic equipment including the Da Vinci Xi HD robotic system which is used by Dr. Gautam to perform robotic prostate cancer surgery on his patients.

For our overseas patients, the medical center has a well staffed and efficient international patients’ division which caters exclusively to and facilitates the treatment of our guests from abroad. Facilities include currency exchange, exclusive pharmacy counters, interpreters for all major global languages, pick up and drop facilities from the airport, comfortable and economical guest house accommodation and visa paperwork.

Contact Details

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

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

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

To read his blog on recovery after robotic surgery for prostate cancer, please click here.

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

To watch a video on robotic 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.