Stage 4 Prostate cancer treatment in New Delhi, India
Stage 4 Prostate cancer treatment in New Delhi, India
In this page, Dr Ashish Sabharwal who is a prostate cancer specialist at Indraprastha Apollo Hospital in New Delhi, India gives full details regarding stage 4 or advanced prostate cancer including its signs and symptoms and full details regarding latest treatments for stage IV prostate cancer in New Delhi India.
What is test for prostate cancer?
What are the signs and symptoms of stage 4 prostate cancer?
First of all , there are symptoms related to prostate enlargement like difficulty in urination or reduced urine flow or needing to go to the bathroom frequently.
Some patients may experience blood in urine or Urinary Blockage and even kidney swelling and kidney failure.
Other symptoms can be due to the spread of cancer to other parts of the body.
- If the cancer has spread to the lymph nodes, there can be swelling of the legs.
- If the cancer has spread to the nerves in the pelvic region, then there can be pain in the legs.
- If the cancer spread to the bones, there can be backache or leg pain or hip pain or in severe cases fracture of the bones like pelvic fracture or spine fracture.
- There can also be paralysis due to spread of cancer into the spinal cord.
- If the cancer spreads to chest, there can be fluid in the lungs and breathing difficulty.
- If the cancer spreads to the head and neck area, there can be headache or even seizures.
What are the tests to be done for diagnosis of stage IV prostate cancer?
- PSA: The first step is PSA. It is a simple blood test and normally value is less than 4 and any value more than 4ng/ml can be prostate cancer.
When the cancer reaches stage four at that time the PSA value is usually more than 20.
The higher the PSA the more the chances that it will be an advanced stage 4 prostate cancer. - Transrectal Ultrasound Guided Prostate Biopsy : Next is the Prostate Biopsy. The prostate biopsy gives the Gleason grading of the prostate cancer and usually in stage 4 prostate cancer, the Biopsy grading is Gleason 8, 9 or 10.
- PSMA PET CT scan: The most sensitive test to diagnose advanced stage 4 prostate cancer is PSMA PET CT scan. Here a intravenous dye is injected into the body which goes and attaches wherever there are cells of Prostate. And then a pet CT scan is diagnosed to pick up the signals of the cells up taking the prostate cancer. Wherever there is prostate cancer either within the prostate or outside the prostate and any other parts of the body, the PET scan picks those areas and tells us if the cancer has gone beyond the prostate into other parts of the body.
What are the various treatment options IV stage for prostate cancer?
- In case of urinary blockage: TURP or Transurethral resection of prostate: To open up the blockage and make a channel for clear urine passage.
- Bilateral orchiectomy or removal of the testicles: The testes produced testosterone hormone which stimulates prostate cancer cells. So we can remove the testicles to suppress the prostate cancer.
- Hormone injections: LHRH agonists and antagonists: They can also be injected if patient does not want removal of the testicles and their function is to reduce the testosterone levels in the body and suppress the prostate cancer. They have to be taken for life time in cases of advanced or metastatic prostate cancer.
Hormone Therapy with Surgery
Surgical removal of the testicles is called orchiectomy or castration. The testes produce testosterone. So after the testicles are removed, the testosterone is not produced in body and the growth of prostate cancer is controlled.
This is a day-care surgery and patients can go home the same day. The surgeon makes a small cut in the scrotum and removes the testes through that.
The benefits of doing the architect me out that it is a simple procedure with few risks. It is a one-time procedure and affective right away. The testosterone levels drop significantly within 24hours.
It is cheaper in the long run because there is no recurring cost of expensive hormone therapies.
Side-effects include infection and bleeding. These are side-effects common with any surgery. Removing the testicles causes a reduction in the testosterone levels, which is a normal male hormone. So it has all the side-effects in the long run of reduction of testosterone in the body. Another problem about removal of testicles is the issue of body image as the Scrotal sack is now empty. Some men choose to have artificial testicular implants based on this to come to help the scrotum look full as before.
Another option is sub capsular orchiectomy. This removes the gland inside the testicle but it leaves the testicular covering intact, so the scrotum looks normal.
Hormone Therapy with Medicines:
Hormone Therapy Side Effects:
Unfortunately, the hormone therapy may not work forever, and it does not cure the cancer. Over time, the Prostate cancer may start growing in spite of the low testosterone level, and other treatments may be needed to manage the cancer.
Hormone therapy is not as bad as chemotherapy and it is different from chemotherapy. The side-effects of hormones is much lesser than chemotherapy.
The possible hormone therapy side-effects include:
Loss of libido ( sexual desire) in most men
Erectile dysfunction, which is the inability to have or keep erections strong enough for sex.
Hot flashes or sudden spread of warmth to the face, neck and upper body, heavy sweating.
Weight gain of 10-15 pounds. Regular exercise, healthy diet and eating less fatty foods will help maintain the body weight.
Mood swings
Depression including feeling loss of hope ,loss of interest in enjoyable activities, Changes in appetite and sleeping
Fatigue ( feeling tired) That does not go away with rest or sleep
Anaemia (low RBC count) due to less oxygen getting to tissues and organs, causing tiredness or weakness.
Loss of muscle mass causing weakness or loss strength
Weak bones
Memory loss
High cholesterol specially the LDL bad cholesterol
Breast nipple tenderness or increase breast tissue growth
increased risk of diabetes
May increase cardiovascular risk
Chemotherapy For Prostate Cancer Treatment:
The chemotherapy medicines are used when the hormone therapy fails. These drugs can slow the growth of cancer. They reduce the symptoms and extend the life. They may ease the pain and reduce the symptoms by shrinking tumours.
Most chemotherapy medicines are given through the vain (intravenous or IV). During chemotherapy the drug move throughout the body. They killed quickly growing cancer cells and non-cancer cells.
Side-effects may include hair loss, fatigue, nausea, and vomiting. There are high chances of infection as the immunity reduces. There may be tingling and numbness of the hands and feet. Due to the side effects of chemotherapy they are usually the last line of treatment when hormone therapy medicines fail.
Immunotherapy For Prostate Cancer Treatment:
Immunotherapy uses the body’s immune system to fight the cancer. It is the treatment of choice for men with metastatic castrate resistant prostate cancer who have no symptoms or only mild symptoms.
Side effects are often experience in the first 24 hours after treatment and they include fever chills weakness headache nausea vomiting and diarrhoea. Patients also have low BP and Rashes.
Bone Targeted Therapy
Prostate cancer many commonly spread to the bones. This causes weakening of the bones leading to bone pain and bone fractures.
The bone targeted therapy means providing medicines to make the bones stronger this includes calcium vitamin D, other drugs to make the bones stronger like Zolendronic Acid.
Radiopharmaceuticals are drugs with radioactivity. These medicines are used for patients suffering from bone pain from metastatic prostate cancer. Radio pharmaceuticals give of small amounts of radiation that go to exact parts where cancer cells are growing.
Drugs like Zolendronic acid helps to reduce bone turnover. The siding effects include low calcium, worsening kidney function and rarely, destruction of the jawbone.
Radiation Therapy For Metastatic Stage 4 Prostate Cancer:
Why choose Dr Ashish Sabharwal as your prostate cancer specialist in New Delhi, India?
Dr Ashish Sabharwal trained in United States of American especially for Prostate cancer treatments. And he does all the treatments which are currently available in the world for prostate cancer including robotic surgery at one of the best hospitals in India that is Apollo Hospital in New Delhi.
To see the patient testimonials click here!!
Cytoreductive prostatectomy improves survival outcomes in patients with oligometastases: a systematic meta-analysis
Stage 4 Prostate Cancer treatment
Definition of oligometastatic disease in prostate cancer:
- Less than 5 metastasis on imaging including lymph nodes; bones and vertebrae and no visceral metastasis.
Research has shown that cytoreductive surgery offers some therapeutic benefits in certain cancer types including ovarian cancer, metastatic renal cell carcinoma, and pancreatic neuroendocrine tumors.
Whether cytoreductive prostatectomy (CRP) should be performed in patients with oligometastatic prostate cancer (OPC) remains controversial.
Results of meta-analysis suggest that cytoreductive surgery may confer certain survival benefits to prostate cancer patients with oligometastatic disease
Cytoreductive prostatectomy improves survival outcomes in patients with oligometastases: a systematic meta-analysis:
Yifeng Mao1,2, Mingqiu Hu1,2,3*, Gaowei Yang3, Erke Gao3 and Wangwang Xu3 Mao et al. World Journal of Surgical Oncology (2022) 20:255