Understanding Prostate Cryotherapy
An exciting new treatment option for prostate cancer treatment is cryosurgery also known as cryotherapy. Because it is minimally invasive, cryotherapy as a prostate cancer treatment is gaining favor among patients and doctors. It also has fewer complications than surgery. Studies show cryotherapy can be an effective alternative to surgery and radiation for appropriate patients, particularly men who develop prostate cancer in their late 60’s or early 70’s.
Cryotherapy is actually not a new concept; this procedure has been explored in various forms over the past few decades. But new cryotherapy techniques and technology are making the procedure much more popular. In recent years, newer technology, including the use of transrectal ultrasound imaging, temperature sensors and cryoablation “needles” versus probes to freeze has made prostate cryotherapy much safer and easier.
Modern prostate cryotherapy is usually in a hospital with the patient under local anesthesia. Using ultrasound guidance, several ultra thin cryoablation needles are placed directly through the patient’s perineum (the place between the scrotum and anus) and into the prostate. The urologist can see each needle entering the prostate with the transrectal ultrasound, and guide the needle to its exact placement. Once the needles are in place, argon gas is released into the needles, where it circulates and plunges the temperature. As the tissue around the needles freeze, the formation and expansion of ice crystals within the cancerous cells cause the cells to rupture and die.
After approximately 10 minutes, the urologist completes the first freeze cycle and then administers another treatment to help ensure that all cancer cells are killed. To keep the urethra from freezing along with the prostate, a catheter is placed inside the urethra and filled with warming solution. Thermal sensors track temperatures in and around the prostate to avoid damaging the bladder and rectum.
The entire procedure takes one to two hours and most patients undergoing prostatic cryotherapy will have the procedure done as a single day out-patient or spend one night in the hospital. At the conclusion of the procedure, the needles are removed from the patient, no stitches are required. Most patients resume normal activity in less than one week. Some may experience temporary bruising and swelling. Usually, a urinary catheter is left in place for one to three weeks for internal healing, and then removed.
After the procedure, the urologist who performed the procedure will order tests to determine the extent of treatment success. Once known, the information is provided to the doctor, who will give the information to the patient.
There is no special preparation needed to undergo cryotherapy, although some physicians recommend ibuprofen a half-hour before the procedure to relieve minor discomfort. Antibiotics are also given beforehand as a way to guard against infection.
Cryotherapy offers several advantages: there is no major surgery or radiation, recovery time is rapid, and most patients return to their normal lifestyle. Unlike radiation, cryotherapy is repeatable if prostate-confined cancer recurs, and it can also be used as a secondary treatment when other primary treatments fail. A recent study (October 2003) showed that 97% of patients treated with new-generation minimally invasive cryotherapy were still cancer-free after twelve months. In longer term study published in May 2002, cryotherapy outcomes using PSA measurement reported the seven year disease-free success statistics were:
- 92% success for low risk disease
- 89% success for medium risk disease
- 89% success for high risk disease
With cryotherapy, controlling cancer confined to the prostate in about 90 percent of men, the results are encouraging. However, this procedure, as does all procedures, has disadvantages. In some patients, incontinence, urethral scarring, and damage to the rectum may occur. The procedure may not kill all of the cancer cells; this is rare unless the patient has been previously radiated. Other possible side effects include:
- Severe to moderate pelvic pain
- Tissue sloughing
- Scrotal swelling
- Blood in urine
- Mild urinary urgency
In most cases the side effects usually go away within a few weeks, and most men will regain normal bowel and bladder function.
Choosing a treatment for prostate cancer isn’t easy. Many physicians feel that this modern technology only recently has the long-term effectiveness to recommend the procedure. Today’s traditional choices include surgery, radiation, hormone therapy and now cryotherapy. At the present time, there are hundreds of urologists and medical centers that have experience with cryotherapy for prostate cancer. With recent longer term data now available, prostate cryotherapy using modern technology may be a treatment choice for you. Ongoing clinical studies are currently being performed on selected patients, including those whose prostate cancer has grown back after failure of radiation therapy or on patients with advanced prostate cancer.