15 Frequently Asked Questions : Prostate Cancer Treatment and Surgery in India for Bangladeshi Patients

Q1 · What is Prostate Cancer Treatment and Surgery?

Prostate cancer treatment involves medical and surgical approaches used to control or treat cancer arising in the prostate.

The appropriate treatment depends on whether the cancer is

• Localised to the prostate
• Locally advanced
• Recurrent after previous treatment
• Metastatic or spread to other parts of the body

Active Surveillance

Some patients with lower-risk prostate cancer may be monitored closely rather than receiving immediate treatment.

Monitoring may involve

• PSA testing
• Digital rectal examination when appropriate
• Repeat MRI
• Repeat biopsy when indicated
• Regular specialist review

Radical Prostatectomy

Radical prostatectomy involves removal of the prostate gland and usually the seminal vesicles.

The procedure may be performed through

• Open surgery
• Laparoscopic surgery
• Robotic-assisted surgery

Robotic-Assisted Radical Prostatectomy

Robotic surgery uses specialised instruments controlled by the surgeon. It may be considered for selected patients with localised or appropriately selected locally advanced prostate cancer.

Radiation Therapy

Radiation may be delivered externally or, in selected patients, through brachytherapy.

Hormone Therapy

Androgen-deprivation therapy (ADT) reduces the effect of male hormones that can stimulate prostate cancer growth.

Chemotherapy

Chemotherapy may be used in selected patients with advanced or metastatic prostate cancer.

Advanced Systemic Treatment

Depending on tumour characteristics and disease stage, selected patients may receive

• Novel hormonal medicines
• Targeted medicines
• Immunotherapy in selected circumstances
• Radiopharmaceutical treatment

The treatment plan should be individualised after complete staging.

Q2 · How much does Prostate Cancer Treatment and Surgery cost in Bangladesh compared with India?

Prostate cancer treatment costs vary according to cancer stage, treatment type, technology, hospitalisation and whether the patient requires surgery, radiation, hormone treatment or systemic therapy.

For planning purposes, this guide uses

• US$1 ≈ BDT 122
• US$1 ≈ INR 96

Indicative Prostate Cancer Treatment Cost Comparison

Note: Potential savings are indicative only and are not guaranteed. The final cost may be substantially different depending on the patient's cancer stage, treatment pathway, medicines, technology and duration of treatment.

Patients should ask whether the quotation includes

• Urologist or uro-oncology fees
• Surgical team fees
• Anaesthesia
• Operating-room charges
• Robotic-system charges, if applicable
• Hospital room
• Nursing
• ICU, if required
• Pathology
• Imaging
• Surgical consumables
• Medicines
• Catheter-related care
• Blood products
• Radiation planning
• Radiation sessions
• Hormone medicines
• Additional procedures
• Follow-up consultations

Patients should also confirm whether chemotherapy, hormone therapy, targeted treatment or radiopharmaceutical treatment is included or billed separately. Bangladeshi patients should obtain a detailed written quotation and clarify all inclusions and exclusions before travelling.

Q3 · Which Indian cities can Bangladeshi patients consider for Prostate Cancer Treatment and Surgery?

Bangladeshi patients may consider major Indian medical cities where urology, uro-oncology, radiation oncology, medical oncology, advanced imaging and cancer surgery are available.

The appropriate city should be selected based on the patient's diagnosis, treatment requirements, specialist availability, expected duration of treatment and follow-up needs.

Q4 · Which hospitals in India can Bangladeshi patients consider for Prostate Cancer Treatment and Surgery?

Bangladeshi patients can consider hospitals offering urology, uro-oncology, robotic surgery, radiation oncology, medical oncology and multidisciplinary cancer services.

Patients should confirm that the selected centre provides the specific prostate cancer treatment required and whether robotic surgery, radiation, brachytherapy or advanced systemic treatment is available for their case.

Q5 · What types of Prostate Cancer Treatment and Surgery are available?

Treatment depends on the patient's risk category, stage and overall health.

1. Active Surveillance

Selected patients with lower-risk prostate cancer may be monitored rather than treated immediately.

2. Radical Prostatectomy

The prostate and seminal vesicles are removed surgically.

3. Robotic-Assisted Radical Prostatectomy

A minimally invasive approach may be considered for selected patients.

4. Nerve-Sparing Prostatectomy

When oncologically appropriate, the surgeon may attempt to preserve nerves involved in erectile function.

Whether nerve-sparing is possible depends on the tumour's location and extent.

5. Pelvic Lymph-Node Dissection

Selected patients may undergo removal of pelvic lymph nodes during prostate surgery.

6. External-Beam Radiation Therapy

Radiation is delivered from outside the body to the prostate and, when indicated, surrounding areas.

7. Stereotactic Body Radiation Therapy

Selected patients may receive highly focused radiation over a smaller number of treatment sessions.

8. Brachytherapy

Radioactive sources are placed inside or near the prostate in selected patients.

9. Hormone Therapy

Androgen-deprivation therapy may be used alone or alongside radiation or other treatments.

10. Chemotherapy

Chemotherapy may be considered in selected advanced or metastatic cases.

11. Advanced Hormonal Treatment

Selected patients may receive newer androgen-receptor pathway medicines.

12. Radiopharmaceutical Treatment

Certain advanced prostate cancers may be treated with targeted radioactive medicines when appropriate.

13. Treatment for Recurrent Prostate Cancer

Patients whose cancer returns after surgery or radiation may have additional treatment options depending on where and how the cancer has returned.

Q6 · Who may be suitable for Prostate Cancer Treatment and Surgery?

Treatment suitability depends on the cancer's risk and stage.

Important factors include

• PSA level
• PSA trend
• Biopsy findings
• Gleason score
• Grade Group
• Number and percentage of positive biopsy cores
• Tumour location
• MRI findings
• Cancer stage
• Lymph-node involvement
• Presence of metastases
• Age
• General health
• Previous treatment

Patients with localised prostate cancer may be considered for

• Active surveillance
• Surgery
• Radiation therapy

Patients with locally advanced disease may require combinations of

• Surgery
• Radiation
• Hormone therapy
• Other systemic treatment

Patients with metastatic disease generally require systemic treatment, although local treatment may still be considered in selected circumstances. The final treatment decision should be made after complete evaluation.

Q7 · What tests are required before Prostate Cancer Treatment and Surgery?

The work-up depends on the patient's diagnosis and risk category.

PSA Testing

PSA is an important blood marker used in prostate cancer evaluation and follow-up.

Digital Rectal Examination

A specialist may perform a digital rectal examination when clinically appropriate.

Prostate MRI

Multiparametric MRI may help evaluate

• Tumour location
• Suspicious areas
• Local extension
• Relationship with nearby structures

Prostate Biopsy

A biopsy is generally required to confirm prostate cancer.

The pathology report may include

• Gleason score
• Grade Group
• Tumour involvement
• Number of positive cores
• Percentage of involvement

Staging Investigations

Depending on the risk category, patients may undergo

• CT
• Bone scan
• PET-based imaging
• PSMA PET imaging in selected circumstances
• MRI

Preoperative Assessment

Patients undergoing surgery may require

• Complete blood count
• Kidney function
• Liver function
• Blood glucose
• Coagulation profile
• ECG
• Anaesthesia assessment

Not every patient requires every test.

Q8 · What medical records should Bangladeshi patients send before travelling?

Bangladeshi patients should send their complete prostate cancer medical file for specialist review.

Recommended records include

• PSA reports
• PSA trend over time
• Prostate biopsy report
• Histopathology report
• Gleason score
• Grade Group
• Number of positive biopsy cores
• MRI prostate report
• Actual MRI images
• CT scan report, if performed
• Bone scan report, if performed
• PSMA PET report, if performed
• Actual PET/CT images
• Previous surgery records
• Previous radiation records
• Hormone-treatment records
• Chemotherapy records
• Current medication list
• Recent blood tests
• Previous discharge summaries

Patients who have already undergone treatment should provide the complete treatment timeline, including treatment dates and response assessments.

Q9 · How does Prostate Cancer Treatment and Surgery work?

The treatment pathway depends on the cancer risk and stage.

Step 1: Diagnosis

PSA testing, examination, MRI and biopsy are used to establish the diagnosis.

Step 2: Risk Assessment

The team evaluates

• PSA
• Grade Group
• Gleason score
• Tumour extent
• MRI findings
• Clinical stage

Step 3: Staging

Additional imaging may be used to determine whether the disease has spread beyond the prostate.

Step 4: Treatment Planning

A urologist or uro-oncology team may work with radiation and medical oncology specialists to determine the appropriate approach.

Step 5: Definitive Local Treatment

For selected localised cancers, treatment may involve

• Radical prostatectomy
• Robotic-assisted prostatectomy
• Radiation therapy
• Brachytherapy

Step 6: Systemic Treatment

Patients with higher-risk, recurrent or metastatic disease may require hormone therapy or other systemic treatments.

Step 7: Pathology After Surgery

If prostatectomy is performed, the removed prostate is examined to determine the final pathological stage and tumour characteristics.

Step 8: PSA Follow-Up

PSA is monitored after treatment according to the treating team's schedule.

Step 9: Additional Treatment

If cancer remains or returns, additional radiation or systemic treatment may be considered depending on the individual situation.

Q10 · What are the alternatives to Prostate Cancer Surgery?

Surgery is only one treatment option.

Active Surveillance

Selected patients with lower-risk cancer may be monitored carefully.

Radiation Therapy

Radiation may be used as a definitive treatment for selected localised or locally advanced cancers.

Brachytherapy

Selected patients may receive internal radiation treatment.

Hormone Therapy

Hormone therapy may be used with radiation or as systemic treatment for advanced disease.

Chemotherapy

Selected patients with advanced or metastatic prostate cancer may receive chemotherapy.

Advanced Hormonal Treatment

Newer hormonal medicines may be used for selected patients.

Radiopharmaceutical Therapy

Selected advanced cancers may be treated with targeted radioactive medicines.

Symptom-Directed Treatment

Patients with advanced disease may require treatment to control pain, urinary problems or complications associated with metastatic disease.

The appropriate alternative depends on the patient's risk category, stage and previous treatment.

Q11 · What should Bangladeshi patients ask before accepting a Prostate Cancer Treatment quotation?

Patients should ask detailed questions before confirming treatment.

Diagnosis

• What is the exact prostate cancer risk category?
• What is the Gleason score?
• What is the Grade Group?
• What is the PSA level and trend?
• Has the cancer spread outside the prostate?

Surgery

• Is radical prostatectomy recommended?
• Is robotic surgery appropriate?
• Is nerve-sparing surgery possible?
• Will pelvic lymph nodes need to be removed?
• What are the risks of urinary incontinence and erectile dysfunction?

Radiation and Systemic Treatment

• Could radiation be an alternative to surgery?
• Is hormone therapy required?
• Is chemotherapy required?
• Is advanced hormonal treatment appropriate?
• Is PSMA-targeted radiopharmaceutical treatment relevant?

Cost and Hospitalisation

• What exactly is included in the surgery quotation?
• Are robotic-system charges included?
• Are pathology and imaging included?
• Are medicines included?
• How many hospital days are expected?

Travel and Follow-up

• How long should the patient stay in India?
• When can the patient safely travel home?
• How often should PSA be checked?
• Can further treatment be continued in Bangladesh?
• What follow-up will be required after returning home?

Patients should request a written treatment plan and detailed cost estimate.

Q12 · How long should Bangladeshi patients stay in India?

The duration depends on the selected treatment. For radical prostatectomy, a broad planning estimate may be: Hospital stay: approximately 2–5 days for an uncomplicated operation, although individual recovery varies. Total India stay: approximately 1–3 weeks may be appropriate for some international surgical patients. Patients receiving radiation therapy may require a longer stay depending on the treatment schedule. Patients undergoing hormone therapy, chemotherapy or advanced treatment may have a different treatment timeline.

Before booking return travel, patients should obtain clearance from the treating team and confirm that

• The urinary catheter, if used, is appropriately managed
• Wounds are satisfactory
• There are no major complications
• The patient can travel safely
• Follow-up arrangements are established

Q13 · What is recovery like after Prostate Cancer Treatment and Surgery?

Recovery depends on the treatment received.

After radical prostatectomy, patients may initially experience

• Fatigue
• Abdominal or pelvic discomfort
• Urinary leakage
• Temporary urinary urgency
• Catheter-related discomfort
• Changes in sexual function
• Reduced physical stamina

Urinary Recovery

Temporary urinary incontinence can occur after prostate surgery. Pelvic-floor exercises may be recommended.

Sexual Function

Erectile function can be affected after prostate surgery.

The likelihood and degree of recovery depend on factors including

• Age
• Baseline erectile function
• Nerve involvement by cancer
• Nerve-sparing feasibility
• Surgical technique
• Other health conditions

Recovery can take time and varies between individuals.

Physical Activity

Walking is generally encouraged as recovery progresses, while strenuous activity and heavy lifting may need to be restricted temporarily.

Catheter Care

Some patients leave hospital with a urinary catheter for a period determined by the surgical team.

PSA Monitoring

PSA testing is an important part of follow-up after definitive treatment.

Recovery After Radiation

Radiation may cause urinary, bowel or sexual side effects, depending on the treatment technique and individual response.

Q14 · How can follow-up be managed after returning to Bangladesh?

Before returning to Bangladesh, patients should obtain a complete treatment file.

This should include

• Final diagnosis
• Cancer stage
• Gleason score
• Grade Group
• Final pathology report, if surgery was performed
• Operative report
• Lymph-node results
• Radiation-treatment summary, if applicable
• Hormone-treatment records
• Chemotherapy records
• Medication list
• PSA follow-up schedule
• Imaging recommendations
• Follow-up instructions

After prostatectomy, PSA is typically monitored according to the treating team's schedule.

Follow-up may involve

• PSA testing
• Urology review
• Oncology review
• Assessment of urinary function
• Assessment of sexual function
• Hormone-treatment monitoring
• Imaging when clinically indicated

Patients can continue routine follow-up with an appropriate urologist or oncologist in Bangladesh while maintaining communication with the treating team in India when necessary. Urgent medical attention should be sought for symptoms such as severe pain, high fever, significant bleeding, inability to pass urine, severe weakness or other concerning changes.

Q15 · Should a Bangladeshi patient travel to India for Prostate Cancer Treatment and Surgery?

The decision should be based on the patient's individual cancer risk category, stage, treatment requirements, medical suitability and follow-up arrangements.

Before travelling, patients should establish

• Exact diagnosis
• PSA level and trend
• Gleason score
• Grade Group
• Cancer stage
• MRI findings
• Whether lymph nodes are involved
• Whether distant disease is present
• Whether surgery is appropriate
• Whether robotic surgery is appropriate
• Whether radiation is an alternative
• Whether hormone therapy is required
• Whether additional systemic treatment is required
• Expected treatment duration
• Estimated cost
• Follow-up requirements in Bangladesh

Some patients may be appropriately managed with active surveillance rather than immediate treatment. Others may require surgery or radiation, while patients with advanced disease may require systemic treatment. A complete review of the patient's PSA reports, biopsy pathology, MRI and staging investigations before travel can help establish the likely treatment pathway and whether an in-person prostate cancer consultation in India is appropriate.