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Deciphering Prostate Biopsy: procedure and risk factors.

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Prostate Diseases

Deciphering Prostate Biopsy: procedure and risk factors.

Prostate biopsies are operations when tissue samples are taken from the prostate. During a prostate biopsy, tissue samples are extracted from your prostate gland using a needle. 

A urologist is a medical professional who specializes in male sex organs and the urinary system.

 

What is the definition of a prostate biopsy? 

During a prostate biopsy, a small sample of tissue from the prostate gland is removed for microscopic examination. It is carried out to look into anomalies found during prostate cancer screening, like increased levels of the antigen specific to the prostate or unusual results from a digital rectal exam. The biopsy aids medical professionals in identifying the presence of prostate cancer as well as other disorders that impact the prostate gland, such as infection or inflammation. The best urologist in Ludhiana is known for treating the urological conditions. 

 

What are the causes of the prostate biopsy? 

A prostate biopsy aids in the identification or exclusion of prostate cancer. In the following scenarios, your doctor might recommend a prostate biopsy:

  • A PSA test produces results that are higher than usual for your age
  • Your doctor may find a palpable lump or hard consistency in the prostate during a digital rectal exam.
  • Although the results of your prior biopsy were average, your PSA levels on monitoring are continuously rising.
  • A previous biopsy had shown abnormal cells.

 

Procedure of the prostate biopsy. 

Numerous techniques are available for taking prostate biopsy samples. Your prostate biopsy may comprise the following procedures.

  • Transrectal biopsy: During the transrectal biopsy, a small needle is inserted into the prostate and via the rectum to extract a sample of tissue. Through transrectal ultrasonography, the needle is directed. To determine whether the sample contains cancer, a histopathologist uses special stains to examine it under a microscope. 
  • MRI/TRUS Fusion Biopsy: Transrectal Ultrasonography is referred to as TRUS. It uses an ultrasonic probe to take a real-time picture of the prostate gland. To get a targeted prostate biopsy, fusion guided prostate biopsy combines ultrasonography and magnetic resonance imaging. Patients with consistently elevated PSA results despite a negative biopsy in the past and prostate lesions that are difficult to target, like those located anteriorly precisely, may consider this approach.
  • Transperineal biopsy: A small incision is made in the skin between the anus and the scrotum. The biopsy needle is inserted into the prostate through the incision to get tissue samples. Usually, this treatment is guided by images. 

 

Risk of prostate biopsy

The following are among the risks of a prostate biopsy:

  • Blood at the site of the biopsy. Bleeding following a prostate biopsy is not uncommon.
  • Your semen is bloody. A common side effect of a prostate biopsy is the appearance of crimson or rust-coloured semen. There is blood present, but this is not a reason for alarm. After the biopsy, there can still be blood in your semen for a few weeks.
  • Urine with blood in it. Usually, this bleeding is not too severe.
  • Having trouble urinating. Urinary problems may occasionally arise following a prostate biopsy. Rarely does the need to install a temporary urinary catheter occur.
  • Infection. On rare occasions, a prostate biopsy may result in an infection that needs to be treated with antibiotics for the urinary tract or prostate.

For kidney cancer treatment in Ludhiana, schedule a consultation with the best doctor at RG Stone Urology & Laparoscopy Hospital.

Categories
Prostate Diseases

Define prostate cancer.

Prostate cancer is cancer that occurs in the prostate. The prostate is a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate gland, where they do not cause serious harm. 

 

Definition of Prostate cancer.

Prostate cancer develops in the prostate, a small walnut-shaped gland located below the bladder and in front of the rectum in men and people assigned male at birth. This tiny gland secretes fluid that mixes with semen, keeping sperm healthy for conception and pregnancy. The best urologist offers you appropriate prostate cancer treatment in Ludhiana.

 

What are the causes of prostate cancer?

Several reasons cause prostate cancer. 

  • Benign Prostatic Hyperplasia: BPH is a benign prostatic enlargement typically observed in older men. Urinary symptoms like increasing frequency, urgency, a weak urine stream, and trouble starting or stopping peeing are caused by the prostate gland’s tendency to enlarge with age, compressing the urethra.
  • Prostatitis: Prostatitis is the term for an infection or inflammation of the prostate gland. It can produce symptoms including pelvic pain or discomfort, ejaculation pain, trouble peeing, and frequent urine. It can also be acute or chronic.
  • Prostate Cancer: One of the most prevalent malignancies in males is the prostate. In the prostate gland, it happens when aberrant cells proliferate out of control. An individual’s age, race, family history, and some genetic characteristics are risk factors for prostate cancer.
  • Prostate stone: Small calcifications called prostate stones can develop inside the prostate gland. Infections, urine retention, or persistent inflammation can all lead to their development. Urinary tract issues, discomfort, and even the need for medical intervention can result from prostate stones, even though they may not always show symptoms.

 

Symptoms of prostate cancer. 

Symptoms are infrequent in early-stage prostate cancer. As the illness worsens, several problems could arise:

  • Frequent, sometimes urgent, need to pee, especially at night.
  • Weak urine flow or flow that starts and stops.
  • Pain or burning when you pee.
  • Loss of bladder control.
  • Loss of bowel control.
  • Painful ejaculation and erectile dysfunction.
  • Blood in semen or pee.
  • Pain in your lower back, hip or chest.

 

Definition of robotic uro-oncology surgery.

Robotic surgery is A minimally invasive surgery requiring fewer cuts than traditional open surgery. The procedure is carried out by a surgeon seated at a console, using a joystick to operate automated tools. The surgeon makes tiny incisions in the body to insert the instruments, and then manipulates them to do the surgery.

 

The Role of Robotic Uro-Oncology Surgery in Treating Prostate Cancer.

  • Enhanced surgical precision: Compared to traditional surgical instruments, robotic instruments are more accurate and can perform delicate movements with more precision. The patient may benefit from this in terms of surgical outcomes.
  • Shorter hospital stay: Compared to traditional surgery, robotic surgery with minimal incisions results in a quicker hospital stay.
  • Quicker recovery: Robotic surgery is less invasive than traditional surgery; patients recover more quickly and often have less pain.
  • Reduced risk of complications: Robotic surgery can improve patient outcomes by reducing the possibility of issues developing during and after the treatment.
  • Reduced blood loss: Robotic surgery is less invasive than traditional surgery; patients often lose less blood.

The best urologist in Ludhiana suggested the treatment plans, and the primary treatment for prostate cancer is surgery. For treating prostate cancer, contact the RG Stone Urology & Laparoscopy Hospital for appropriate treatment. 

Categories
Prostate Diseases

Prostate Enlargement and How it can be Managed

The prostate gland is found in men or people assigned male at birth (AMAB). It is a part of the Male reproductive system. It is positioned below the urinary bladder. It hides the rectum behind it. You can feel the prostate from the rectum. It is about the size of a small lemon. It encompasses the urethra, a tube like structure connected to the urinary bladder, and empties its content. It also produces fluid that goes to the semen, and its muscles contract to push the semen through the urethra.

ENLARGEMENT OF PROSTATE

Enlargement of the prostate is primarily seen in older male adults. This is Benign Prostatic Hyperplasia (BPH). It can put pressure on the urethra, causing it to taper, and the bladder cannot drain its contents. It causes the bladder to retain urine. One should not mistake prostate enlargement for prostate cancer. Prostate enlargement also leads to other health issues like urinary tract infections and kidney problems.

It would help if you remember that these conditions can also indicate other underlying health conditions; you must consult an expert urologist in Ludhiana for a proper diagnosis.

Factors causing Prostate Enlargement

The exact reason for the occurrence of Prostate Enlargement is unknown. But it is possible that ageing and mutation in the testicular cell structure can be one of the causes.

FACTS ABOUT PROSTATE ENLARGEMENT

– The likelihood of developing an enlarged prostate increases with age.

– BPH is so common that it is said that all men will have an enlarged prostate if they live

Long enough.

– a small proportion of men over forty years have enlarged prostate and about ninety percent of men over 80 years have prostate enlargement.

– Men who have had their testicles removed at a young age due to any other conditions does not develop BPH.

– If a man’s testicles are removed after he has developed BPH, then the prostate shrinks in

Size. However, remember this is not the standard treatment for an enlarged prostate.

Above mentioned information does not qualify as an expert opinion. It would be best if you visited a licensed Urologist in Ludhiana.

SYMPTOMS OF PROSTATE ENLARGEMENT

Less than 50% of men suffering from enlarged prostate show symptoms. Some of them may include:

  1. a) Increase in the frequency of urination.
  2. b) Need to urinate two to three times per night.
  3. c) Difficulty in urination (need to apply pressure)
  4. d) blood in urine and pain during urination(may indicate infection)
  5. e) weak urine stream or dribbling.
  6. f) Urinary tract and kidney infection.
  7. g) Urinary incontinence ( inability to prevent urine from leaking from the urethra).
  8. h) Strong and sudden urge to urinate.
  9. i) Slowed or delayed onset of the urinary stream. Etc.

ROLE OF DIET IN MANAGING ENLARGED PROSTATE

It is common knowledge that a balanced diet is crucial as we age, but it becomes all the more critical in the context of BPH. Scientists believe that a Balanced diet rich in vitamins and nutrients can have a role in preventing enlarged prostate, as it is observed that some of the conditions of an enlarged prostate can be managed by following dietary guidelines that is shared by the diet specialist doctor and managing fluid intake.

Some of the food you must add to your diet are:

a)Fresh fruits and vegetables (rich in Fibre),

b)broccoli, brussels sprouts, kale(rich in Vitamin C), 

c)Flaxseed (rich in Omega 3 fatty acids),

d)Tomatoes, apricots, watermelons(rich in Lycopenes). Etc.

FOODS THAT CAN PREVENT BPH

-Avocado

-Sesame seeds

– Bell pepper

-Tofu

– Onion and garlic

– Nuts

CONCLUSION

Benign prostatic hyperplasia (BPH) is a common condition affecting a significant portion of the population. One can easily manage the condition by regulating diet and fluid intake. Getting a proper diagnosis from a reputed UROLOGIST is advisable. Some good urologists are based in PUNJAB in general and LUDHIANA in particular.

Categories
Prostate Diseases

प्रोस्टेट की बीमारी के बारे में कैसे जानें ?

प्रोस्टेट ग्रंथि क्या है इसके बारे में कैसे पता लगाया जा सकता है। और प्रोस्टेट ग्रंथि के अंदर कौनकौन से रोग शामिल होते है साथ ही प्रोस्टेट बीमारी किसके साथ जुडी हुई होती है, इसके बारे में हम बात करेंगे।

प्रोस्टेट ग्रंथि क्या है ?

प्रोस्टेट ग्रंथि पुरुषो से जुड़ा हुआ होता है, जिसके बारे में हम निम्न में बात करेंगे ;

  • प्रोस्टेट एक ग्रंथि है जो केवल पुरुषों में ही होती है। यह एक अखरोट के आकार के बराबर होता है और यह मूत्राशय की ग्रीवा के नीचे मूत्राशय के निकास (मूत्रमार्ग) के इर्दगिर्द मौजूद होता है।

  • तो वही प्रोस्टेट एक दूधिया तरल पदार्थ बनाता है, जो वीर्य का एक अंश होता है और शुक्राणुओं के लिए भोजन के रूप में काम करता है।

यदि आप भी प्रोस्टेट में किडनी की पथरी का सामना कर रहें है, तो हो जाए सावधान।

प्रोस्टेट बीमारी क्या है ?

प्रोस्टेट ग्रंथि क्या है के बारे में तो हमने जान ही लिया है पर अब हम जानेंगे कि प्रोस्टेट बीमारी क्या है ;

  • प्रोस्टेट हार्मोन टेस्टोस्टेरोन द्वारा विनियमित होता है और एक तरल पदार्थ का उत्पादन करता है, जिसे वीर्य कहा जाता है। वीर्य शुक्राणु युक्त तरल पदार्थ है जो वीर्य स्खलन के दौरान मूत्रमार्ग से बाहर निकलता है।

  • जब प्रोस्टेट में कोशिकाओं की असामान्य, घातक वृद्धि से ट्यूमर बन जाता है, तो इसे प्रोस्टेट कैंसर या प्रोस्टेट की बीमारी कहा जाता है।

  • प्रोस्टेटाइटिस एक ऐसी स्थिति है, जिसमें प्रोस्टेट ग्रंथि सूज जाती है। अमूमन, सूजन किसी संक्रमण की प्रतिक्रिया के रूप में होती है। लेकिन प्रोस्टेटाइटिस के अधिकांश मामलों में संक्रमण का कोई सबूत नहीं मिलता।

प्रोस्टेट की बीमारी के बारे में और जानने के लिए यूरोलॉजिस्ट लुधियाना से जरूर संपर्क करें।

प्रोस्टेट का बढ़ावा किस उम्र से होना शुरू होता है ?

प्रोस्टेट का तो पता ही है कि ये पुरुषो से जुडी हुई एक ग्रंथि होती है, तो बात करते है कि इसका बढ़ावा किस उम्र में शुरू हो जाता है ;

  • प्रोस्टेट का बढ़ना , बढ़ती उम्र से जुड़ी एक सामान्य स्थिति है । 50 साल से ज्यादा आयु के लगभग हर तीसरे आदमी में प्रोस्टेट के बढ़ने संबंधी लक्षण पनपने शुरू हो जाते हैं।

  • तो वही कुछ वैज्ञानिकों का मानना है कि जब कोई व्यक्ति 25 वर्ष की आयु तक पहुंचता है, तो उसका प्रोस्टेट बढ़ने लगता है। आयु बढ़ने के साथसाथ इस ग्रंथि का आकार बढ़ना एक सामान्य प्रक्रिया है

बढ़े हुए प्रोस्टेट के आम लक्षण क्या है ?

इसके लक्षण हम निम्न में प्रस्तुत कर रहे है, जिसे जान के आप इससे खुद का बचाव कर सकते है, जैसे ;

  • ये आपके पेशाब करने की शुरुआत को काफी मुश्किल बना सकती है।

  • ये आपके पेशाब करने के प्रवाह को कमजोर कर सकती है।

  • पेशाब करने में आपको ज़्यादा ज़ोर लगाना पड़ सकता है।

  • बारबार पेशाब करना पड़ सकता है।

प्रोस्टेट के लक्षणों या प्रोस्टेट के अंदर जितनी भी बीमारियां आती है उसके बारे में जान के इसके उपचार के लिए आप आरजी हॉस्पिटल का चुनाव कर सकती है। इसके इलावा आप इस हॉस्पिटल की ऑफिसियल वेबसाइट पर जाकर भी अपनी परेशानी के बारे में जानकारी हासिल कर सकते है।

निष्कर्ष :

उम्मीद करते है कि आपको प्रोस्टेट क्या है के बारे में पता चल गया होगा। इसके इलावा इसके जटिल लक्षण दिखने पर फ़ौरन आपको डॉक्टर का चुनाव कर लेना चाहिए और किसी भी तरह की दवाई व उपचार को डॉक्टर के परामर्श पर ही शुरू करें।

Categories
Prostate Diseases

How to improve your prostate health?

If we look at the stats, most people face prostate cancer after Skin cancer. And the worst part of this health issue is that people have no idea about prostate health, its signs, and symptoms, so they can work on their prostate health.

This post will discuss everything about prostate health, tips to improve your prostate health, and getting it treated by the best urologist for a better & healthy life.

What is the Prostate?

The prostate is a small walnut-shaped gland in the male’s body, with the help of which the male body can produce seminal fluids with the help of which they can nourish and transport sperm. Unfortunately, as discussed earlier, prostate cancer is one of the most faced cancer types, and it slowly spreads all over the prostate gland, and later people face serious health issues.

Ways to improve prostate health

Although it is suggested that one should schedule frequent checkups with the help of which you can keep an eye on your prostate health. If you have never gone on a prostate health checkup, we suggest you contact the best urologist in Ludhiana for your checkup and further treatments, if any.

1- Healthy body weight:

The first way to improve prostate health is by maintaining healthy body weight. It has been noticed that obesity is linked with plenty of prostate health-related issues such as prostate cancer and more.

If you maintain a healthy body weight, you can neglect health issues linked with your prostate.

2- More vegetables in the diet:

Adding plenty of vegetables to your diet can enhance the value of vitamins and antioxidants in your body, which helps you maintain better prostate health. Try adding several green vegetables to your diet such as spinach, lattice, broccoli, and many more.

3- Neglect non-veg diet:

There are plenty of chemical compounds in non-veg diets that are not good for our overall and prostate health. That’s why it is suggested to neglect non-vegetarian diets and only opt for a vegetarian diet.

4- Workout daily:

Most of us keep sitting and working for long hours, unaware that this issue leads to prostate issues in our bodies; if you want to get rid of such issues or never face a prostate health problem, you should work out daily.

Initially, you can start walking for 30 minutes, and later you can also start weight training.

5- Drink more water:

If you want to get better prostate health you should drink at least 8 cups of water, this is the reason those who don’t hydrate themselves properly face prostate health issues.

6- Relax & reduce stress:

Ensure you provide at least 7-8 hours of sleep to your body. Also, try to do a few activities with the help of which you can reduce your stress.

7- Stop drinking alcohol & smoking:

If you are drinking alcohol or smoking daily, we suggest you stop doing these activities for better prostate health and never face prostate cancer-related issues.

 

Categories
Advanced Urology Prostate Diseases

What is Bladder Cancer – Symptoms & Risk Factors

Bladder cancer is one of the most common cancers known to medical science. It is reported that men are at a higher risk of developing bladder cancer than women. Although it can affect individuals of any age, older adults are at a greater risk to have bladder cancer.

The bladder is located in the lower abdomen region and is a muscular organ. The internal lining of the organ is the first site where bladder cancer starts developing. While most of the time the problem is reported in the bladder region only, cancer can also affect other parts of the urinary tract drainage system in humans.

 

What are the key symptoms of bladder cancer?

The common signs and symptoms of bladder cancer include:

  • Blood in the urine (hematuria)
  • Painful urination
  • Pelvic pai

If you are passing bloodied urine or urine that is cola coloured, you must consult your doctor at the earliest. It is not necessary that blood in urine is only because of bladder cancer as there can be any other infection or growth that can induce this condition.

Back pain and frequent urination are also common symptoms of bladder cancer.

Different types of bladder cancer?

There are three types of bladder cancer Urothelial carcinoma, Squamous cell carcinoma, and Adenocarcinoma. The origin cells of cancer decided that type of cancer in the bladder.

Who are at a higher risk of developing bladder cancer?

Some of the key risk factors of bladder cancer include:

  • Smoking is one of the common reason as to when you smoke, you inhale a range of hazardous chemicals into your system.
  • Age is also a common risk factor as the immunity of the body decreases with age.
  • It is reported that white people are at a higher risk of developing bladder cancer than people of other races.
  • Men are also more exposed to the risk of bladder cancer than women.
  • Exposure to dyes, rubber, leather, textiles and paint products and chemicals used in their production can also increase your chances to get bladder cancer.

It is important to seek the right help at the right time to fight bladder cancer.

Categories
Advanced Urology Prostate Diseases

Enlarged Prostate – Causes, Symptoms & Treatment Options

Enlarged Prostate

An enlarged prostate is a condition that affects men where the prostate gland has increased in size. Clinically defined as benign prostatic hyperplasia (BPH), this condition is not cancer; neither does it increase the patient’s chances of developing cancer. While the prostate increases in size as a male grows, it is imperative to note that an older man will have a bigger prostate than that of a younger man. This condition is dangerous for when it comes to urination and the fact that in treating the condition, the man is susceptible to developing problems in their sexual ability. The effects due to this condition are dependent on age, genetics, and the level of anxiety as displayed by the patient.

Causes

Multiple factors lead to the development of an enlarged prostate. First is an alteration in the balance of sex hormones. This happens as the man grows older. Thus

  • Aging: Chances of developing an enlarged prostate increases as the man grows older
  • Family history: In case your father had an enlarged prostate the there is a high probability of you also developing the condition
  • Diabetes and heart conditions: These conditions influence the formation of an enlarged prostate owing to the fact that they involve the beta-blockers, thereby increasing the chances of developing an enlarged prostate.
  • Lifestyle: Lifestyle conditions like obesity have the potential to increase the risk of an enlarged prostate. On the other hand, exercise lowers the risk.

Symptoms

There are certain symptoms associated with an enlarged prostate including:

  • A frequent need to urinate
  • The feeling that your bladder is not completely emptied after urination
  • A weak urine stream
  • Problems starting or stopping urination
  • Presence of blood in the urine
  • Erectile dysfunction
  • Reduced libido
  • Problems maintaining an erection

Treatment Options

Multiple approaches are used in treating an enlarged prostate. Men must have their prostates screened regularly particularly the ones over 40, 45, and 50 years because these ages are the prime time for an enlarged prostate. In treating, multiple options are applicable in efforts to reduce the acuteness of this condition.

Surgical options

This is in the event that medication fails to eliminate the symptoms. These surgical approaches include:

  • The transurethral resection of the prostate (TURP): This involves the cutting out of the prostate tissue.
  • There is also the transurethral incision (TUIP) of the prostate: Here, grooves are made or created on the prostate
  • The third is the transurethral microwave thermotherapy (TUMT): this involves the use of microwaves in destroying the excess prostate tissue.
  • The prostatic urethral lift: this involves the movement of the prostate tissue away from the urethra.

Research has revealed that changes in the victim’s lifestyle can influence and get rid of the symptoms that are associated with an enlarged prostate. These include the reduction of the consumption of alcohol, sweeteners, and soda.

Categories
Advanced Urology Prostate Diseases

Prostate Cancer – Treatment Options

With changing lifestyle preferences, Prostate cancer has become one of the common problems reported in males. In case you have discomfort in your groin area, swelling, or pain while urinating, you might have Prostate cancer. It is advised to see a doctor as soon as possible. If you are diagnosed positive for prostate cancer, you will be guided for the various treatment options available for the condition.

While the doctor would guide you the best, it is important to have knowledge about the treatment options available to you. In this article, we have discussed all the possible treatments for prostate cancer. The doctor might recommend any one of these or advise a combination. The selection depends upon a range of factors including the stage of cancer, your health condition, medical history, and more.

Radiation therapy for prostate cancer

Radiation therapy uses photons to kill cancerous cells. The ionizing radiation is targeted on the cancerous cells for killing their DNAs. Once coming in contact with the radiation, the cancer cells die without multiplying or regenerating. The treatment is appropriate when prostate cancer is local. It is as effective as surgery and offers great results. You will have to connect with a radiation oncologist who will arrange your radiotherapy sessions. There are two types of radiotherapy:

  • External Beam Radiation Therapy (EBRT): EBRT is commonly used radiotherapy to treat prostate cancer. The radiologist, with the help of mapping, identifies the location of the cancer cells and target them specifically.
  • Brachytherapy: In this therapy, the experts implant radiation seeds inside the prostate. These seeds emit radiation internally, killing the cancerous cells.

Surgery for prostate cancer

In case, cancer has not spread, doctors suggest removing the prostate gland through surgery. The procedure is called radical prostatectomy. However, in case, cancer has spread and formed a more advanced stage, the doctors work on the removal of the lymph nodes.

Open radical prostatectomy is the conventional way of operating the prostate gland and removing it. However, nowadays laparoscopic prostatectomy has become more popular. Irrespective of the type, a prostatectomy is a critical procedure, followed by a tough healing process. Surgery is often combined with other treatments such as Hormone therapy and Radiation therapy. The doctors might also recommend chemotherapy once the surgical wound is completely healed.

Hormone therapy for prostate cancer

It is believed that testosterone is one of the fuelling elements for the development of prostate cancer. Through Hormone therapy for prostate cancer, the doctors focus on minimizing the levels of testosterone in the body. The treatment is also known as androgen deprivation therapy or ADT and is used in a case where metastasis has happened. The therapy works on stopping the production of Testosterone or limits its contact with the prostate.

Chemotherapy for prostate cancer

The primary goal of chemotherapy is to restrict cancer from spreading to other sites. It is a critical procedure with lots of side effects. The oncologists administer medicine to your veins which acts on the cancerous cells. However, the high effects of the medicine can easily be observed by healthy cells as well. The result is a complete body imbalance. The side-effects range from nausea to vomiting, constipation to loose motions, headaches to fatigue, and a lot more. Its prime focus is to improve the quality of life and increase life span.

Immunotherapy for prostate cancer

Cancerous cells are harmful to the body and our immune system is designed to work against them.  However, when a patient has a progressive prostate cancer condition, the immune system can become weak. Immunotherapy works on the immune system of the body and retrains immune cells to respond to the malicious cells.

Some of the common types of immunotherapies include

These are some of the key treatments available for Prostate Cancer. An experienced prostate cancer expert can help you identify the best treatment for your condition and fight with prostate cancer effectively.

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