What Every Man Needs to Know
A Patient Guide by Dr. Rohit Dadhwal
Urologist & Robotic Surgeon | Fortis Hospital, Mohali
Important:
Prostate cancer is highly curable when detected early. This guide will help you understand the disease, recognise warning signs, and know your treatment options — including the latest robotic surgery techniques.
1. What is the Prostate Gland?
The prostate is a small walnut-shaped gland found only in men. It sits just below the bladder and surrounds the urethra — the tube through which urine and semen pass out of the body. Its main job is to produce a fluid that forms part of semen, helping to nourish and transport sperm.
Prostate cancer occurs when cells in the prostate gland begin to grow in an uncontrolled manner. Unlike many other cancers, prostate cancer often grows very slowly — and many men live for years without even knowing they have it. However, some forms are aggressive and need prompt treatment.
2. How Common is Prostate Cancer?
Worldwide
Prostate cancer is the second most commonly diagnosed cancer in men across the world. Every year, more than 1.4 million new cases are reported globally, making it a truly significant public health concern.
In India
In India, prostate cancer is among the top five cancers in men, and its incidence is rising steadily. The age-standardised incidence rate in India ranges from about 5 to 19 cases per 100,000 men depending on the region, with urban populations showing higher rates.
Cities like Delhi, Mumbai, Bengaluru, and Chandigarh consistently report higher numbers, likely because of greater awareness and better access to diagnostic testing.
Key Fact:
Prostate cancer is predominantly a disease of older men. More than 70% of cases are diagnosed in men above the age of 65. However, Indian men are increasingly being diagnosed in their 50s.
Why is it Increasing in India?
• More awareness and wider use of PSA blood tests leading to more diagnoses
• Urbanisation, sedentary lifestyle, and Western-style diets
• Increasing life expectancy — men are living longer
• Obesity, which is linked to more aggressive prostate cancer
3. What are the Risk Factors?
Understanding your risk can help you take early action. The main risk factors include:
| Risk Factor | What it means |
|---|---|
| Age | Risk rises sharply after age 50 |
| Family History | Father or brother with prostate cancer doubles your risk |
| Ethnicity | More common in men of African origin; less common in Asian men — though rising in India |
| Diet | High fat, high red meat diet may increase risk; fruits and vegetables may be protective |
| Obesity | Linked to more aggressive and harder-to-treat prostate cancer |
| Smoking | Associated with more aggressive disease and poorer outcomes |
4. Symptoms — When Should You Worry?
Early prostate cancer usually has NO symptoms. This is why screening is so important for men above 50. Symptoms usually appear when the cancer has grown larger or has spread.
Common Symptoms to Watch For
• Difficulty in starting or stopping urination
• Weak or interrupted urine flow
• Frequent urination — especially at night (getting up multiple times)
• Burning or pain during urination
• Blood in urine or semen
• Painful ejaculation
• Difficulty achieving or maintaining an erection
• Pain or stiffness in the lower back, hips, or thighs (may indicate spread to bones)
Important:
These symptoms can also be caused by a non-cancerous enlarged prostate (BPH — Benign Prostatic Hyperplasia), which is very common in older men. Only proper tests can tell the difference.
Please consult a Urologist — do not ignore these symptoms.
5. How is Prostate Cancer Diagnosed?
Prostate cancer diagnosis involves a stepwise approach. Your doctor will typically follow these steps.
Step 1 — PSA Blood Test
PSA stands for Prostate-Specific Antigen. This is a simple blood test. A higher than normal PSA level can indicate prostate cancer, but it can also be elevated due to other causes like infection or an enlarged prostate.
A raised PSA is a signal to investigate further — not a final diagnosis.
Step 2 — Digital Rectal Examination (DRE)
The doctor gently examines the prostate by inserting a gloved finger into the rectum. This helps detect any hard or abnormal areas in the prostate.
It takes only a few seconds and is an important part of the examination.
Step 3 — MRI Scan of the Prostate
An MRI scan gives a detailed picture of the prostate and surrounding structures.
Modern multiparametric MRI (mpMRI) can identify suspicious areas with high accuracy and guides the biopsy.
Step 4 — Prostate Biopsy
A biopsy involves taking small tissue samples from the prostate using a thin needle. The samples are examined under a microscope by a pathologist.
This is the only definitive way to confirm the diagnosis of prostate cancer.
The biopsy also gives a Gleason Score, which indicates how aggressive the cancer cells are.
Step 5 — Staging Scans
Once prostate cancer is confirmed, staging scans such as:
• Bone scan
• CT scan
• PSMA PET scan
are done to check whether the cancer has spread.
PSMA PET Scan:
This is a highly advanced nuclear medicine scan now widely available in India. It is extremely sensitive in detecting even tiny deposits of prostate cancer.
6. Staging — Understanding How Far the Cancer Has Spread
| Stage | What it means |
|---|---|
| Localised | Cancer confined within the prostate gland. This is the most curable stage. |
| Locally Advanced | Cancer has grown just outside the prostate but has not reached distant organs. |
| Metastatic | Cancer has spread to lymph nodes, bones, or other parts of the body. |
The treatment your doctor recommends depends heavily on the stage of your cancer, your age, and your overall health.
7. Treatment Options
For Localised Prostate Cancer
Active Surveillance
For low-risk, slow-growing cancers — especially in elderly men — the cancer is monitored closely with regular PSA tests, MRI scans, and repeat biopsies.
Radiation Therapy
High-energy beams are used to kill cancer cells.
This can be delivered externally (EBRT) or via radioactive seeds (Brachytherapy).
Modern techniques like IMRT and VMAT deliver radiation very precisely.
Robotic Surgery (Robotic Radical Prostatectomy) — The Gold Standard
Robotic-assisted surgery is currently the most preferred surgical treatment for localised prostate cancer worldwide.
The entire prostate gland is removed using robotic arms controlled precisely by a trained surgeon.
For Locally Advanced and Metastatic Prostate Cancer
• Hormone Therapy (Androgen Deprivation Therapy — ADT)
• Chemotherapy
• Immunotherapy and targeted therapies
• Radiation combined with hormone therapy
• PSMA-based Lutetium therapy
8. Robotic Surgery for Prostate Cancer — The Future is Here
Robotic Radical Prostatectomy is considered the gold standard surgical treatment for localised prostate cancer.
At Fortis Hospital Mohali, we perform this procedure using the 4th generation Da Vinci Xi robotic system.
What is Robotic Surgery?
In robotic surgery, the surgeon sits at a console and controls robotic arms that operate inside the patient’s body.
The robotic system provides:
• 3D high-definition magnified vision (10x magnification)
• Tremor filtration
• Seven degrees of instrument movement
• Millimetre-level precision
How is the Operation Done?
The operation is performed through 4–5 tiny holes (less than 1 cm) in the abdomen.
The entire prostate gland along with the seminal vesicles is removed.
The bladder is then reconnected to the urethra.
The operation usually takes 2 to 3 hours.
Benefits of Robotic Prostatectomy over Traditional Surgery
| Advantage | Robotic Surgery Benefit |
|---|---|
| Blood Loss | Significantly less |
| Pain | Much less post-operative pain |
| Hospital Stay | Usually only 2–3 days |
| Recovery Time | Back to normal activity in 2–3 weeks |
| Precision | Superior precision |
| Infection Risk | Much lower |
| Cancer Control | Equivalent or better cancer control |
| Scarring | Minimal scars |
9. Nerve Sparing Surgery — Protecting Your Quality of Life
One of the most important advances in prostate cancer surgery is the nerve-sparing technique.
Running along both sides of the prostate are neurovascular bundles responsible for erections.
Robotic surgery allows surgeons to identify and preserve these delicate nerves.
Benefits of Nerve Sparing
✓ Better chances of recovering erectile function
✓ Better recovery of urinary continence
✓ Preservation of sexual quality of life
✓ Improved overall wellbeing
10. Recovery After Robotic Prostatectomy — What to Expect
During Your Hospital Stay (Days 1–3)
• Wake up in recovery room
• Urinary catheter in place
• Pain medications given
• Walking encouraged next day
• Diet begins with liquids
• Discharge usually Day 2 or 3
First Two Weeks at Home
• Walk regularly
• Catheter removed at 7–10 days
• Temporary urinary leakage may occur
• Avoid heavy lifting
• Keep wounds clean and dry
Weeks 3 to 6
• Return to desk work in 2–3 weeks
• Pelvic floor exercises (Kegel exercises) are important
• Urinary control improves gradually
Urinary Continence Recovery
Most men recover full urinary control within 3–12 months.
Pelvic floor exercises are extremely important.
Sexual Function Recovery
Recovery may take 6 months to 2 years depending on age and nerve sparing.
Medications such as sildenafil (Viagra) may help.
PSA Follow-Up — Monitoring for Cure
After surgery, PSA should drop to undetectable levels.
Regular PSA testing every 3–6 months confirms cure.
11. Frequently Asked Questions
Q: Is prostate cancer always life-threatening?
No. Localised prostate cancer detected early is highly curable.
Q: At what age should I get screened?
Men above 50 years should discuss PSA screening with their doctor. With family history, start at 40–45 years.
Q: Hospital stay after robotic surgery?
Usually 2–3 days.
Q: Will I have normal sex life after surgery?
Many men recover erectile function with nerve-sparing robotic surgery.
Q: Is robotic surgery expensive?
Upfront cost may be slightly higher, but faster recovery and fewer complications make it cost-effective.
Q: What if cancer has already spread?
Modern treatments can control the disease effectively for many years.
A Message from Dr. Rohit Dadhwal
Prostate cancer is no longer a death sentence. With today’s advanced diagnostic tools and the precision of robotic surgery, we can offer most men with localised prostate cancer an excellent chance of complete cure — while protecting what matters most to their quality of life.
If you are above 50, please do not ignore urinary symptoms. A simple PSA blood test could save your life.
Early detection is the best weapon against prostate cancer.
For consultations and appointments:
Department of Urology & Robotic Surgery, Fortis Hospital, Mohali.
Dr. Rohit Dadhwal
MCh Urology (AIIMS, New Delhi) | Robotic Surgery | Uro-Oncology
Fortis Hospital, Mohali, Punjab, India