Adenocarcinoma of the prostate is the clinical term for a cancerous tumor on the prostate gland. As prostate cancer grows, it may spread to sac-like structures attached to the prostate (seminal vesicles), to tissues near the prostate, the interior of the gland, and to distant parts of the body (bones, liver, lungs, etc). The prostate gland is located in the pelvis, below the bladder, above the urethral sphincter and penis, and in front of the rectum in men. It is made up of glandular tissue and muscle fibers that surround a portion of the urethra. The gland is covered by a membrane (called the prostate capsule) that produces prostate-specific antigen (PSA). Early prostate cancer is usually discovered during a routine digital rectal xamination (DRE). Symptoms are often similar to those of benign prostatic hyperplasia (BPH). Men observing the following signs and/or symptoms should see their physician for a thorough examination:

• • Blood in urine or semen
• • Frequent urination, especially at night
• • Inability to urinate
• • Nagging pain or stiffness in the back, hips, upper thighs, or pelvis
• • Painful ejaculation
• • Pain or burning during urination (dysuria)
• • Weak or interrupted urine flow

Along with age related benign enlargement the incidence of prostate cancer also increases with age. A small percentage of patients presenting with symptoms of prostate enlargement may have cancer in the prostate. Early diagnosis and judging the stage of cancer accurately holds the key to curative treatment and best plan of management. This is achieved by a special blood test (PSA), clinical examination, a special (transrectal) ultrasound and accurate biopsies.

Along with age related benign enlargement and incidents of prostate cancer increases. A small percentage of patients presenting with symptoms of prostate enlargement may have cancer in the prostate.

1. Laparoscopic Radical Prostatectomy/Open R P

This is an effective and usually curative treatment for early Prostate Cancer. The entire prostate and some surrounding structures are removed and urinary passage re-established. Laparoscopy provides similar cancer clearance related outcomes to open radical prostatectomy but is more patient friendly, less invasive and has shorter hospitalisation and early recovery. The high magnification and clear visualisation helps in reducing bleeding and achieving better continence and potency results.

2. Radiotherapy and Brachytherapy

In selected cases of early prostate cancer, these are alternative modalities to surgery especially in medically unfit patients. Working as a part of multidisciplinary team for urological cancer, Dr. Paruliya has gained good experience in the finer technical aspects and management.

3. Screening Programme (Urological / Cancer)

Just like USA and Scandinavian countries, we provide screening programmes for early detection of prostate cancer and comprehensive urological check-up for individuals and company executives.

Treatment of prostate cancer depends upon the stage of the disease and patient's age and overall health. Elderly patients with minor symptoms, early stage of cancer, or coexisting illnesses may be treated conservatively. Watchful waiting is a reasonable course of action for patients who are elderly, in poor health, or in early cancer stage. Untreated prostate cancer may take years to become problematic. During this time, the physician monitors the patient's condition for any marked or sudden progression of the disease, which may signal the need for more aggressive treatment.

Surgical Treatment of Prostate Cancer
Radical Prostatectomy
Bilateral Orchidectomy

Radical prostatectomy is the surgical removal of the prostate gland and surrounding tissues including seminal vesicles and pelvic lymph nodes. Surgeons use one of two surgical techniques, retropubic prostatectomy or perineal prostatectomy. General anesthesia is used in both procedures. In retropubic prostatectomy, an incision is made in the lower abdomen. This gives the surgeon access to prostate gland, seminal vesicles, and pelvic lymph nodes. In perineal prostatectomy, the incision is made in the perineum (space between scrotum and rectum). With perineal prostatectomy, a second procedure is required to remove the pelvic lymph nodes, lymphadenectomy.