Cryotherapy for prostate cancer

Overview

Cryotherapy for prostate cancer freezes prostate tissue, causing cancer cells to die. As a minimally invasive procedure, cryotherapy for prostate cancer is sometimes used as an alternative to surgical removal of the prostate gland.

In the past, cryotherapy for prostate cancer was associated with significantly higher levels of long-term side effects than were other prostate cancer treatments. Advances in technology have reduced these side effects. Many men, however, still experience long-term sexual dysfunction following cryotherapy for prostate cancer.

Cryotherapy might be used to treat men who have early-stage prostate cancer. Cryotherapy for prostate cancer can also be an option for men whose cancer has returned after other treatments.

Why it's done

Cryotherapy freezes tissue within the prostate gland. After being frozen, the prostate cancer cells die.

Your doctor may recommend cryotherapy for prostate cancer as an option at different times during your cancer treatment and for different reasons. Cryotherapy might be recommended:

• As the primary treatment for cancer, usually for early-stage cancer that is confined to your prostate
• After other cancer treatment, such as radiation therapy, to stop the growth of prostate cancer that has returned

Cryotherapy for prostate cancer generally isn't recommended for men:

• Who have normal sexual function
• Who previously had surgery for rectal or anal cancer
• Whose prostates can't be monitored with an ultrasound probe during the procedure
• Who have large tumors that can't be treated with cryotherapy without damaging surrounding tissue and organs, such as the rectum or bladder

Researchers are studying whether cryotherapy to treat one part of the prostate might be an option for cancer that's confined to the prostate. Termed "focal therapy," this strategy identifies the area of the prostate that contains the most aggressive cancer cells and treats that area only. Studies have found that focal therapy reduces the risk of side effects. But it's not clear whether it offers the same survival benefits as treatment to the entire prostate.

Risks

Side effects of cryotherapy for prostate cancer can include:

• Erectile dysfunction
• Pain and swelling of the scrotum and penis
• Frequent, difficult or painful urination
• Blood in your urine
• Loss of bladder control
• Bleeding or infection in the area treated

Rarely, side effects can include:

• Injury to the rectum
• Blockage of the tube (urethra) that carries urine out of the body
• Infection or inflammation of the pubic bone

How you prepare

Your doctor may recommend a fluid solution (enema) to empty your colon, and an antibiotic to prevent infection during the procedure.

What you can expect

During cryotherapy for prostate cancer

Cryotherapy for prostate cancer is done in the hospital. You may be given a general anesthetic, or your doctor may numb only the surgical area with a local or regional anesthetic.

Once the anesthetic takes effect, your doctor:

• Places an ultrasound probe in your rectum.
• Places a catheter inside the tube (urethra) that transports urine from your bladder out of your penis. The catheter is filled with a warming solution to keep the urethra from freezing during the procedure.
• Inserts several thin metal probes or needles through the area between the scrotum and the anus (perineum) into the prostate.
• Watches the images generated by the ultrasound probe to ensure correct placement of the needles.
• Releases argon gas to circulate through the probes or needles, cooling them and freezing nearby prostate tissue.
• Monitors and controls the temperature of the needles and the amount of freezing within the prostate gland.
• May place a catheter into your bladder through your lower abdomen to assist in draining urine after cryotherapy.

After cryotherapy for prostate cancer

You'll likely be able to go home the day of your procedure, or you may spend the night in the hospital. The catheter may need to remain in place for about two weeks to allow for healing. You might also be given an antibiotic to prevent infection.

Cryotherapy for prostate cancer usually results in very little blood loss. You may experience:

• Soreness and bruising for several days where the rods were inserted
• Blood in your urine for several days
• Problems emptying your bladder and bowels, which usually resolve over time

Sexual dysfunction, including impotence, is common after cryotherapy for prostate cancer.

Results

After cryotherapy for prostate cancer, you'll have regular follow-up exams as well as periodic imaging scans and laboratory testing to check your cancer's response to treatment.

The current method of cryotherapy for prostate cancer — which employs ultrasound guidance, newer-technology cryotherapy probes and strict temperature monitoring — has been in use for only several years. The long-term outcomes for this procedure are currently unknown.