Ask your query and problems from Dr. Ajay Sharma
The incidence of prostate cancer is much less in India than in western world. Unfortunately, due to lack of awareness, the prostate cancer is detected when it is already beyond cure. With the routine use of PSA in man over 50 years, we are picking up early cancer and offer them curative treatment by robotic operation.
The diagnosis :- Prostate cancer has no specific symptoms. The best way is to get PSA test once a year. If it is high in relation to age and volume of prostate, and/or on physical examination prostate feels more firm that normal, a trucut biopsy is taken by the urologist.
Usually two reports are desirable especially if there is UTI or Diabetes, where PSA may be falsely high. One doesn't need to be scared after seeing one report of raised PSA.
The timely biopsy diagnose the disease. By the time, symptoms start, usually the cancer is already advanced. TImely diagnosis can cure the cancer in most of the cases. Biopsy report confirms the presence of cancer and its aggressiveness is assessed by Gleason score which can be from 2-10. Score of 8-10 is very aggressive.
The decision of surgery depends upon the stage of cancer and life expectancy of the patient if he did not have the cancer.
If the cancer is limited to the prostate (T1 and T2), the best treatment is robotics radical surgery. It is the main hope of cure.
. If the patient is not fit for operation, he can be treated by ratiotherapy which is nearly as good as surgery. Radiotherapy is the only choice when cancer has come out of prostate but is still within surrounding area (T3). There is evidence that surgery may improve the quality of life even in this group but is not established. Once the cancer has reached the distant area like lymph nodes or bones, the only treatment is hormonal, in form of anti androgen or LHRH agonist injections or surgical removal of testes.
The mainstay of treatment is surgery and it can give about 75% disease free survival for 15 years which one of the maximum in cancer disease.
Dr. Ajay Sharma is performing this operation since 2005, with extraperitoneal Laparoscopic approach , as developed by French surgeons. He performed about 100 operations by this method till he started Robotic surgery. Now all such operations are done with robot, which is many times superior.
The surgery is not without complications. The major complication of bleeding which was very common in open surgery (upto 1 litre blood loss)is generally not seen in laparoscopic surgery and robotic surgery. Other complication like incontinence of urine usually improve by 2-4 weeks, although some stess incontinence may continue for 3-6 months. Other complication is impotence. The technique whereby nerves to penis can be saved, many people will retain potency.