Cryotherapy for prostate cancer

Overview

Cryotherapy for prostate cancer is a procedure to freeze prostate tissue and cause the cancer cells to die. During cryotherapy, thin metal probes are inserted through the skin and into the prostate. The probes are filled with a gas that causes the nearby prostate tissue to freeze.

Cryotherapy might be used to treat early-stage prostate cancer that's confined to one part of the prostate if other treatments aren't an option for you. Cryotherapy for prostate cancer can also be used when the cancer has returned after initial 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 freezes tissue within the prostate gland. This causes the prostate cancer cells to 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 initial treatment for cancer if your cancer is confined to your prostate and other treatments aren't an option for you
• As a treatment for prostate cancer that comes back after your initial treatment

Cryotherapy for prostate cancer generally isn't recommended if you:

• Previously had surgery for rectal or anal cancer
• Have a condition that makes it difficult or impossible to monitor the prostate with an ultrasound probe during the procedure
• Have a large tumor 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
• Blood in the 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

How you prepare

Your doctor may recommend a fluid solution (enema) to empty your colon. You may receive 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 drug called a general anesthetic to put you in a sleep-like state. Sometimes a regional anesthetic is used so that you'll remain aware of your surroundings but won't feel anything in the treatment area.

Once the anesthetic takes effect, your doctor:

• Places an ultrasound probe in your rectum.
• Places a catheter inside the tube (urethra) that carries urine out of the body. 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 a gas to circulate through the probes or needles that causes freezing in the 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.

After the procedure, you may experience:

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

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.