Cryotherapy for prostate cancer

Overview

Cryotherapy for prostate cancer is a treatment that uses extreme cold directly on cancer cells, causing them to die. During cryotherapy, thin metal probes are inserted through the skin and into the prostate. The probes are filled with a gas that freezes nearby tissue.

Cryotherapy, also called cryoablation, might be used to treat early-stage prostate cancer when other treatments aren't an option. It also can be used if the cancer comes back after the first treatment.

In the past, cryotherapy for prostate cancer was associated with more long-term side effects than were other prostate cancer treatments. Advances in technology have reduced these side effects. But long-term sexual dysfunction is still a concern with this treatment.

Why it's done

Cryotherapy for prostate cancer uses extreme cold to treat the cancer. It involves freezing the prostate tissue, which causes the cancer cells to die.

Cryotherapy for prostate cancer may be a treatment option for:

• Early-stage prostate cancer. Early-stage prostate cancers are only in the prostate and haven't spread. For these cancers, cryotherapy might be used if the standard treatments aren't options for you.
• Prostate cancer recurrence. Prostate cancer recurrence happens when the cancer comes back after treatment. Cryotherapy may help treat cancer that comes back in the prostate after radiation therapy.

For prostate cancer, most cryotherapy treatments apply extreme cold to all of the prostate. Sometimes the treatment is given to part of the prostate. Prostate cancer treatments that only treat the part of the prostate that has cancer are called focal therapies. Focal cryotherapy may lower the risk of side effects. But it's not clear whether it offers the same survival benefits as treatment of the whole prostate.

Cryotherapy for prostate cancer isn't an option for everyone. It generally isn't recommended if you:

• Previously had surgery for rectal cancer or anal cancer.
• Have a condition that makes it hard to monitor the prostate with an ultrasound probe during the procedure.
• Have a large cancer that may be difficult to treat without hurting nearby tissue and organs, such as the rectum or bladder.

Risks

Cryotherapy for prostate cancer is a safe procedure. Like all treatments, it has a risk of side effects and complications.

Side effects and risks of cryotherapy for prostate cancer can include:

• Bleeding and infection in the treatment area.
• Pain and swelling of the scrotum and penis.
• Erectile dysfunction.
• Loss of bladder function.
• Blockage of the tube that carries urine out of the body.
• Injury to the rectum.

How you prepare

Follow the instructions from your healthcare team to prepare for cryotherapy for prostate cancer. Your healthcare team may adjust your medicines before your procedure. The care team may ask you to use a fluid solution called an enema to flush waste from the rectum. You typically do the enema at home the night before your procedure.

What you can expect

During cryotherapy for prostate cancer

Cryotherapy for prostate cancer is done in a hospital. You may receive a medicine called a general anesthetic to put you in a sleeplike state so that you aren't aware during the procedure. Sometimes a regional anesthetic is used so that you remain aware of your surroundings but don't feel anything in the treatment area.

Once the medicine takes effect, the healthcare team:

• Places an ultrasound probe in your rectum. This kind of ultrasound is called a transrectal ultrasound.
• Places a catheter inside the tube that carries urine out of the body. The urine tube is called the urethra. The catheter is filled with a warming solution to keep the urethra from freezing during the procedure.
• Inserts several thin metal probes or needles into the skin between the scrotum and the anus. This area of skin is called the perineum. The probes go through the skin and into the prostate.
• Watches the images made by the ultrasound probe to ensure correct placement of the needles.
• Releases a gas to circulate through the probes or needles. The gas causes freezing in the prostate tissue.
• Monitors and controls the temperature of the needles and the amount of freezing within the prostate gland.
• Allows the tissue to thaw and then repeats the freezing and thawing process.
• Removes the probes and places a bandage over the perineum.
• Removes the warming catheter and places a different catheter into the urethra to drain urine from the bladder. Sometimes the team places a catheter into the bladder through the skin on the lower belly to drain urine.

After cryotherapy for prostate cancer

Most people can go home the day of the procedure, but some may need to stay in the hospital. The catheter may stay in place for one or two weeks to allow for healing. Your healthcare team may ask you to take antibiotic medicine to prevent infection.

After the procedure, you may experience:

• Soreness and bruising in the treatment area.
• Blood in your urine for a few days.
• Needing to empty the bladder or pass stool more often, though this gets better with time.

Results

It may take a few months to find out the results of cryotherapy for prostate cancer. Ask your healthcare professional when you can expect to know the results of your procedure.

Healthcare teams typically do prostate-specific antigen (PSA) tests or imaging tests, such as prostate MRI, a few months after cryotherapy to see whether the treatment worked.