Beginning in 2000, we have offered the option of treating prostate cancer with an effective, minimally invasive procedure called cryotherapy (cryoablation, cryosurgery). Cryotherapy entails freezing the cancer by placing needles through the skin. This technique may be performed in an outpatient setting.
Cryoablation therapy includes the following benefits:
- Minimally invasive procedure
- Favorable success rates
- Low complication rates
- Short recuperation period
- May be repeated
- Less costly than other traditional treatments
- Avoids the risks of surgery and radiation
Cryotherapy is performed under spinal or general anesthesia with monitoring of the treatment area with ultrasound imaging and temperature probes to precisely target the cancerous tissue. A warming catheter is used to protect the urethra from the cold temperature, helping maintain its function.
Primary Prostate Cancer Cryotherapy: For patients with a new diagnosis of prostate cancer, cryoablation is offered as an alternative to radical surgery, brachytherapy (seeds), external beam irradiation and HIFU (high-intensity focused ultrasound). The entire prostate gland is treated and follow up is done with routine PSA tests.
Nerve-Sparing Cryotherapy: We are able to treat the prostate gland and avoid the nerves responsible for sexual function. By doing so, a small portion of the prostate gland is not frozen with the hope that the nerves will continue to function properly. Of those men who lose erections postoperatively, 50% of them will regain their erections within 3 years.
Focal Cryotherapy: We are able to treat the specific area where prostate cancer has been found by biopsy. This decreases the risks of side effects and complications. Since cryotherapy can be repeated, we can utilize this technique for smaller areas of cancer. Follow up is done with routine PSA tests with the possibility of more biopsies to confirm that there is no residual or new disease.
Salvage Cryotherapy: If a patient's PSA is rising after external beam irradiation or brachytherapy (seeds), this may indicate a recurrence of cancer within the prostate gland. If this is confirmed by a biopsy and there is no evidence of metastatic disease, cryoablation may be performed to treat local recurrence(s) in the prostate gland. Published data and our own experience indicates this option has a similar cure rate to salvage radical surgery with fewer side effects. This is an excellent alternative to radical surgery.
With Cryotherapy, we are able to freeze the entire gland, perform nerve sparing procedures or pursue focal treatments confined to the area(s) where cancer is found. We are also able to offer a curative option for people who have undergone external beam radiation and/or radiation seed implants who are suffering from a local recurrence of their disease.
What to expect with the Prostate Cryosurgery Procedure:
- 1.5 hours under spinal or general anesthesia
- Discharged later that day or the next day
- Icepacks to scrotum and perineum for 1 day
- Suprapubic or Foley catheter for 1 week
- Anti-inflammatory medications for several days
- Narcotics are not typically needed
- Can start golfing at 10-14 days
Early Side effects of Prostate Cryosurgery:
- Swelling or bruising around scrotum and perineum for up to two weeks
- Urinary retention
- Uncomfortable to sit down (<2 wks)Can start golfing at 10-14 days
Late Side effects of Prostate Cryosurgery:
- Impotence (in full gland treatment) 82-100 % initially, 50% have recovery after 3 years
- Urethro-rectal fistula (0-0.25%)
- Incontinence (1-4%)
- TURP needed (1-5.5%)
Clinical studies have shown the effectiveness of cryotherapy. As with all technical procedures, the results and the risks are determined by the disease process itself, anatomy and the skill & experience of the surgeon.
More information can be found at www.cryocarepca.org