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