Robotic Surgery may prevent long term complications of hormone therapy for prostate cancer

Robotic surgery is now very well established as a leading treatment option for prostate cancer. In suitable patients, it is likely to provide the best long term quality and quantity of life. Even in men with relatively advanced disease (high risk/locally advanced) prostate cancer, robotic surgery offers a speedy recovery with excellent long term survival. However, a relatively under appreciated advantage of this technique is its ability to delay or avoid the need for hormone therapy in a large number of patients with prostate cancer.

Hormone therapy (androgen deprivation therapy in medical jargon) implies removing the male hormone, testosterone from the body by either removing its site of production (surgical removal of both testes, also called surgical castration) or suppressing it with regular injections (medical castration). Since, prostate cancer cells are dependent on testosterone for their growth and spread, this removal or suppression of testosterone in the body generally brings about a decrease in the amount of cancer and keeps the disease under control for a duration of time ranging from months to a few years.

However, hormone therapy takes a significant toll on the body by way of many short and long term complications. It causes fatigue, loss of muscle mass, loss of bone strength which may cause fractures, depression, loss of sexual function and a general slowdown of physical and mental functions. In the long term, it can lead to an increased susceptibility to develop diabetes, high cholesterol and weight gain. It has also been shown recently to increase the chances of having a heart attack or stroke in the future. In fact, the US Food and Drug Administration (FDA) and American Heart Association (AHA) have issued a warning advising a judicious use of hormone therapy in patients with prostate cancer and weighing the risks and benefits before starting this treatment in all patients.

Patients who undergo radiation therapy for prostate cancer also have to take hormone therapy ranging from 6 months to 3 years depending upon the stage and type (grade) of the disease. This is because radiation alone (without hormone therapy) has much inferior results as compared to surgery in most patients with prostate cancer. This addition of hormone therapy to radiation therapy, unfortunately, exposes patients to the combined onslaught of complications and problems associated with radiation as well as hormone therapy.

For suitable patients, choosing to undergo surgery may be the best way to avoid many of these complications, thereby leading to the best possible preservation of quality and quantity of life. While hormone therapy may need to be given even after surgery in certain situations, it has been shown that even in men with a relatively advanced disease (high risk/locally advanced prostate cancer), hormone therapy can be avoided or delayed in more than 50% of patients by choosing to undergo surgery for prostate cancer. Even if hormone therapy is required after surgery, it can be given in an on-off fashion (intermittent androgen deprivation therapy), thereby avoiding a continuous harmful exposure to the body for a long time.

So, while there will always be certain short term problems and risks associated with undergoing surgery, robotic surgery for prostate cancer may be the best treatment option for most patients with prostate cancer – especially in view of the recent realisation in the medical community that hormone therapy for prostate cancer may not be as innocuous as previously thought by many of us !

Dr Gagan Gautam is the head of urologic oncology and robotic surgery at Max Institute of Cancer Care, New Delhi, India. He is one of the leading specialists for prostate cancer treatment in India and is closely involved in the care, counselling and surgical treatment of patients with this disease.  


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

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.