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Radical Prostatectomy Surgery in India

What is Prostatectomy?

Simply speaking, a Prostatectomy procedure is a surgical procedure to remove the Prostate Gland.

Which is the best place for me to get a Radical Prostatectomy?

In the US, a radical prostatectomy can cost you anywhere between USD 4,000 and USD 8,000. These charges include the cost of the surgical procedure and the after-care during the stay in the hospital. The exact cost will be dependent on the individual requirements of minimum time period spent recovering in the hospital and other additional charges.

However, in India, the cost of a radical prostatectomy is only around 25% to 30% of that in the US and most other countries.

Fill the form on this website to know a better estimate of the package for a radical prostatectomy in India. For the exact cost, our doctors will need to evaluate the patient and check the latest medical reports.

Terms used:

• Open Radical Prostatectomy – In this surgical approach, the surgeon will make an incision in the abdomen to remove the prostate gland. This procedure is mostly used to treat prostate cancer cases.

• Radical Prostatectomy (RP) – This surgical approach is used for removing the entire prostate gland along with the seminal vesicles. The surgeon may also remove the nearest lymph nodes for biopsy or permanent removal.

• Radical Retropubic Prostatectomy (RRP) – This is one of the most common methods for performing prostatectomy. In this, an incision will be made, starting from the navel and continuing till the pubic bone (lower abdomen). This surgical approach helps to remove the prostate gland, seminal vesicles and the nearest lymph nodes.

• Radical Perineal Prostatectomy (RPP) – This surgical method involves making an incision in the perineum, the area between the anus and the scrotum. This is not often used as there is increased risk of nerve damage from the surgery. This approach also makes access to the nearest lymph nodes difficult. On the other hand, this surgical approach is less painful and a shorter stay in the hospital after the surgery.

• Laparoscopic surgery – This minimally invasive surgical technique uses a laparoscope, which is a thin and flexible tube. It initially has a high-end video camera and a cold light source attached to its end. Laparoscopes are inserted inside the body through very small (2-4 mm long) incisions. Once inserted, the laparoscope camera allows the surgeon to view the prostate gland on a live video stream to the monitor. The surgeon will attach special miniaturized surgical instruments to the laparoscope and perform the necessary surgical procedure.

• Radical Laparoscopic Prostatectomy (RLP) – An expert and well-trained surgeon can perform this procedure effectively. In this minimally invasive surgery, the surgeon will use a laparoscope to remove the prostate gland.

• Robotic Radical Laparoscopic Prostatectomy (RRLP) – This is an ultra-modern form of laparoscopic prostatectomy which is guided and performed with the help of robot. The surgeon views a 3D imaging system for guidance that allows higher precision in making resection incisions without damaging the surrounding healthy tissue.

• Transurethral Resection of Prostate Gland – This prostatectomy procedure is helpful in removing benign mass or swelling on the prostate gland (also known as Benign Prostatic Hypertrophy). This surgery helps to remove the swollen portion of the prostate gland which is pressurizing the urethra. This condition, if left untreated, can result in severe urinary problems, including urgency and increased frequency of urination. Mostly, men over 50 years of age experience this condition and require this surgical procedure.

Am I an ideal candidate for Radical Prostatectomy?

A localized prostate cancer which is not spreading (metastasizing) to other organs in the surrounding, along with overall healthy status which can sustain a surgical procedure are the main criteria which decide whether you are an ideal candidate for a radical prostatectomy (RP).

How should I prepare for a Radical Prostatectomy?

Prior to the surgery, the doctor will normally advise undergoing tests, including blood and urine analysis, CT (computerized tomography) of the abdomen, chest x-rays and PSA (prostate specific antigen). The doctor should know about any underlying medical condition and current medication (if any).

It is advised to stop ingestion of ibuprofen and aspirin at least 2 weeks prior to the surgery. Smoking should be quit at least a few weeks prior to the surgery as this will affect the rate of recovery. Refrain from eating or drinking anything at least 10 hours before the surgery. The doctor usually advises to be admitted in the hospital the night prior to the surgery.

How is Radical Prostatectomy done?

Let us take a look at the steps involved in each specific surgical technique used for performing radical prostatectomy:

Open Radical Prostatectomy

• This surgery is advised mostly for treating prostate cancer cases in their early stages. In this the surgeon will begin with an incision in the abdomen. This can involve making an incision in the perineal or the retro-pubic way. This incision allows the surgeon to remove the prostate gland and the seminal vesicles.

• The urethra is then connected directly to the bladder and a catheter is attached for around 3 weeks. This surgical approach normally takes around 3 hours to complete and requires administering general anesthesia to prevent pain or discomfort during the procedure.

• An innovative ‘nerve saving technique’ allows the surgeon to now prevent any damage to the surrounding nerves around the prostate gland which can get damaged and cause erectile problems.

• The main complication of this approach is that the surgeon may leave a few cancerous cells which can cause the cancer to return.

Laparoscopic Radical Prostatectomy (LRP)

This minimally invasive surgery is best performed by an experienced and well-trained surgeon. It requires administering either general anesthesia or a spinal anesthesia to prevent pain. The surgeon will make 3 to 4 small incisions to give a multifaceted view of the operating area. The laparoscope efficiently removes the affected prostate gland.

This surgical procedure usually gets completed within 4 hours.

How is recovery after a Radical Prostatectomy?

Following the Radical Prostatectomy, you will normally be in the recovery room for a couple of hours at least, under observation. The doctors will monitor your vital signs, including blood circulation and respiration. The doctors will also check for possible complications arising due to the surgery, such as excessive bleeding.
For laparoscopic radical prostatectomy patients, the hospital stay is usually for only a couple of days. The catheter will normally be removed on the 7th day after the surgery. The doctors advise to resume normal everyday activities after around 4 weeks from the surgery.

In case of an open radical prostatectomy, the hospital stay can last for up to 4 or 5 days. The catheter is removed after about 3 weeks and the patient is able to return to normal everyday activities after 6 to 8 weeks.

In both cases, painkillers are usually prescribed to alleviate pain after the surgery for a few days. Apart from this, the surgeon will give detailed post-operative care instructions. These normally include regular check-ups, rectal exam, monitoring PSA levels and even biopsies of the suspected tissue. A follow-up appointment is normally planned for every 3 months (in the 1st year) and then for every 6 months.

How successful in Radical Prostatectomy?

Radical prostatectomy is remarkably successful in treating prostate cancer (stages I and II) with an 85% success rate. If the PSA levels fall to zero after a radical prostatectomy then this indicates to the successful removal of cancer from the body.

Around 85% of patients treated with radical prostatectomy tend to lose their ability to get erection for several months or even some years. This is especially the case with patients who are less than 60 years of age. Urinary incontinence is also seen in many cases (temporarily) after a radical prostatectomy.

What are the benefits of Radical Prostatectomy?

Radical prostatectomy helps to eradicate cancer in the body by removing the affected prostate gland and the nearest lymph nodes. Open radical prostatectomy gives a better and more convenient access to the surgeon to reach the affected prostate, seminal vesicle and the nearest lymph nodes. It is one of the most common prostatectomy procedures performed all around the world.

Laparoscopic radical prostatectomy, being a minimally invasive surgery, requires a shorter stay in the hospital following the surgery. It also has less pain and a shorter period of recovery, when performed by well-trained surgeons.

Are there any risks associated with Radical Prostatectomy?

These risks and complications are seen in a few cases after a radical prostatectomy procedure:

• Erectile dysfunction (impotence)

• Urinary incontinence

• Infection to incision wound

• Urethral, rectal or ureteral injury

• Nervous or tissue damage

• Inflammation in scrotum or penis

• Hematoma or formation of bruises

Are there alternative treatments apart from Radical Prostatectomy?

Observation – In case radical prostatectomy is not advised or chosen, then the doctor will keep a close watch on the progress of the disease. This is done by careful and regular PSA level checks, digital rectal exam and other such tests, such as:

• Brachytherapy – This treatment involves implanting very small radioactive pills into the prostate gland. These pills are then activated and help to target the radiation from a closer range on the cancerous cells. This is mostly advised for elderly patients and those who are not eligible to undergo a major surgery.

• Cryotherapy – This innovative prostate cancer treatment requires freezing the cancer cells and destroying them. This is not always an accurate procedure and may also freeze healthy prostate cells along with the cancerous cells.

• External Beam Radiation Therapy (ERBT) – This treatment technique involves aiming a sharp beam of radiation from outside the body on to the cancerous prostate gland. This creates intense heat in the cancerous cell and affects the genetic mutation in these cells, thus destroying them effectively.

• Hormonal therapy – This treatment requires administering estrogen or LHRH (luteinizing hormone release hormone) which prevents the production of testosterone from the testicles.

• Orchiectomy – This surgical technique removes the testes. Although this is not aimed at treating the prostate cancer it helps to prevent its spread to other surrounding organs and tissues.

• Transurethral resection of the prostate(TURP) – This surgery is helpful in removing only the cancer-affected portion of the prostate gland or a tissue sample for biopsy.

• TUIP (transurethral incision of the prostate) – This requires making a small incision in the prostate tissue to enlarge the lumen of the urethra along with the outlet of the bladder.

• TULIP (transurethral laser incision of the prostate) – This treatment using a high-intensity and precise laser beam to target and destroy the cancer-affected prostate tissue with greater accuracy.

• VLAP (visual laser ablation of prostate) – In this treatment, laser energy is used to destroy the cancerous prostatic tissue.

• Microwave therapy combined with balloon dilation of prostatic urethra and placement of prostate stents – In this procedure, the aim is to enlarge the narrowed urethral passage through the prostate gland.

• TUVP (transurethral vaporization of the prostate)/Electro-vaporization of the prostate – This technique involves using an electrode to transmit high voltage current which vaporizes the prostate tissue instantly.

When to have a Radical Prostatectomy?

Prostate cancer treatments are varied and diverse allowing the patient various choices. The factors, such as your overall health, age, disorders or diseases and the stage of the prostate cancer help to determine when and what type of prostate cancer treatment is best-suited for your individual case.

How do I decide to undergo a Radical Prostatectomy?

A highly-trained and extensively-experienced surgical team takes care of the treatment of prostate cancer, irrespective of the method being used. These experts can help assure you of the safety and success of the treatment procedures. It is important for prostate cancer to be treated earliest and with effectiveness to prevent complications from arising.

 

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