The Prostate Cryotherapy Procedure
Cryotherapy is used to stop prostate cancer by freezing prostate tissue. During this minimally invasive procedure, a physician inserts multiple needles into the prostate through the perineum (the area between the anus and the scrotum.) This is done under general or spinal anesthesia. During this time, the prostate area is monitored by an ultrasound probe inserted in the rectum.
A foley catheter is also inserted through the urethra into the bladder, and a warm saline solution is circulated to keep the bladder warm and undamaged.
When the needles are in place, argon gas is injected into the needles causing them to drop to very cold temperatures, and instantly creating little "iceballs" of prostate tissue at the needle tips. Once the tissue has been frozen, a different gas is injected into the needle which instantly warms it up. This "quick freeze" causes death of the tissue at the needle tips stopping the cancer.
Post Procedure Recovery
After all the tissue been treated, needles are removed and the procedure is finished. The procedure generally takes a couple of hours, and patients usually go home after 24 to 48 hours. Men will go home with the foley catheter in place that will remain inserted for two or three weeks. It is normal to see a trace of blood in the urine during this time. Patients usually go home on an antibiotic and a medication to keep the bladder from having spasms. Most men are able to return to full activities after several days.
Effectiveness of Cryotherapy
Recent studies indicate that almost 98 percent of patients treated with the new-generation cryotherapy are cancer free after one year, and there is a 95 percent survival rate at five years. It should be mentioned that long term follow up is not yet available for the latest small needle cryotherapy.
Who Should Consider Cryotherapy?
Cryotherapy can be considered by patients who are uncomfortable having a radical prostatectomy, but do not want to take the risk of "watchful waiting." It is now being considered as primary treatment for those with localized tumors, and can also be considered as secondary treatment for those who have had recurrent growth after radiation or other primary treatments.
Cryotherapy treatments can also be repeated if needed.
Side Effects and Risks of Cryotherapy
Impotence is the number one risk for men treated with cryotherapy. Because it is necessary to ensure the destruction of all cancerous tissue, it is often necessary to freeze tissue beyond the prostate wall. Sensitive areas such as nerve bundles and rectal tissue are often damaged during a cryotherapy procedure. When nerves controlling erections are damaged, there can be impotence. It should be noted that depending on how strong erections were prior to treatment, erectile dysfunction may return after some time.
Urethral scarring or urinary incontinence can also be a temporary side effect of cryotherapy that often resolves after a few weeks. Men have also reported blood in the urine, mild urinary urgency, swelling of the scrotum or mild lower abdominal pain-- all of which usually resolve quickly, leaving them with normal bladder and bowel function.
About one percent of men will suffer a complication known as a fistula. This is a hole between the rectum and the urethra caused by tissue damage from the freezing that sometimes needs correction by surgery.
Advantages and Concerns About Considering Prostate Cryosurgery
Advantages:
- Recovery time of a few days
- Low chance of blood transfusions
- Treatment can be repeated if needed
- Can be used before or after other treatments as needed
Concerns:
- New treatment, so little long term effectiveness data.
- Limited number of urologists offering cryotherapy.
