DR. MAYANK MOHAN AGARWAL
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Prostate Cancer Treatment in Lucknow, Uttar Pradesh

Prostate is a walnut sized gland present in the urinary tract just beneath bladder. Its enlargement is very common in men older than 45-50 years. Many times this enlargement leads to urinary tract obstruction (blockade) leading to urinary symptoms of “prostatism” like difficulty in passing urine, slow stream, inability to empty bladder completely, having to go to pass urine frequently or urgently, having to get up at night for urination, leakage of urine, etc. In some cases this prostatic enlargement may lead to bleeding in urine, urinary tract infection or bladder stones. In advanced cases even kidneys can sustain damage due to high pressure urination; this situation can be remarkably minimally symptomatic.

Most cases of symptomatic prostatic enlargement can be effectively managed by medicines which work by relaxing the prostatic muscles and shrinking its size. However, some patients with complications mentioned above or those who are poorly responsive to medications or not tolerating their side effects would need surgery to get rid of their symptoms.

Endoscopic surgery (eponymed TURP) has been the gold standard for removing prostatic obstruction from small to moderate size prostates. Large glands would generally need open surgery requiring cutting though bladder. With the increasing incidences of heart and brain diseases many patients are on blood thinner medicines. Obviously, conventional approaches are not optimal in such situations. LASERS have taken a major leap in prostate surgery; by virtue of excellent physical properties even large prostates can be removed by endoscopic surgery through natural passage with much less bleeding (eponymed HOLEP, ThuLEP, HOLRP, ThuLRP).

Coming back to the prostate enlargement, men of this age are also at risk of developing cancer of prostate, with / without enlargement. Typically, most men with prostate cancer won’t have any significant symptom due to cancer; it is only when it is advanced that symptoms would arise. Research suggests that it may be beneficial to perform screening for prostate cancer in men above 50 (above 40 for those with family history of this cancer) since it can be effectively treated when detected early.  Some patients with very early prostate cancer may be offered an active surveillance strategy (i.e. no active treatment). However, most patients with “clinically significant” cancer would prefer an active treatment. Grossly, two options are available i.e. surgery and radiotherapy. Surgery (Radical prostatectomy) is different from that for benign prostate disease. In the benign prostatectomy, only the central part of prostate which causes blockage is removed, leaving the capsule and blood supply intact. Whereas, for cancer, prostate is removed completely from its roots. Obviously, endoscopic approach through natural passage is not possible. Conventionally, open surgery has been the gold standard providing excellent cancer clearance. With advances in laparoscopic technology especially with advent of surgical robotic system assistance minimally invasive radical prostatectomy has become an equivalent standard. Unlike surgical removal, radiotherapy works by “burning off” the diseased prostate. Conventional radiotherapy would be associated with a high incidence of side effects (many of which would last long). With advancements in radiation technology highly focused beams of radiation can be conferred thus reducing the incidence of side effects. Whether radiation therapy is better or surgery is not entirely clear; however, recent analyses of large population based data favors radical surgery over radiation therapy in terms of long term morbidity, need for hospitalization and death due to disease. Regardless, a multi-step discussion between doctor and patient is the key to decide in an individual case.