Cryosurgery | Prostate Cancer Information

Prostate Cancer

Treatment
Cryosurgery

Cryosurgery (also known as cryotherapy, cryoablation, or cryosurgical ablation) is a procedure in which the prostate gland is frozen under controlled conditions in order to kill cancer cells. Used for many years in the treatment of skin cancer, cryosurgery is currently considered an experimental therapy for prostate cancer because there are no long-term results to document the technique's effectiveness.

Cryosurgery works best on prostates 40 grams or less in size as measured by ultrasound. Three to six months prior to the procedure, the patient is placed on hormone therapy to block production of male hormones, which cause prostate cancer to grow. Hormone therapy shrinks the prostate and cancer prior to cryosurgery and improves the chances of freezing the entire prostate.

The procedure is performed while the patient is under either general or local anesthesia. Special metal probes are inserted through the perineum (the area between the scrotum and anus) and directly into preselected locations in the prostate gland. Liquid nitrogen is then circulated through the probes to freeze the entire gland. The goal is to create an "ice ball" large enough and cold enough to kill the cancer.

An ultrasound probe placed in the rectum guides the placement of the probes, monitors the formation of the ice ball and ensures that the rectal wall is not frozen. A warming catheter filled with a saltwater solution is placed in urethra to keep it warm during procedure. During the procedure, a Foley catheter is inserted to drain urine; it is left in place for two to three weeks. Typical hospital stays are one to two days.

Appropriate candidates for cryosurgery

Men whose cancer is localized to the prostate gland.
Men who haven't had previous prostate surgery, including transurethral resection of the prostate (TURP).
Men whose prostates are 40 grams or less in size as measured by ultrasound.
Men with high Gleason scores. Cryosurgery is used for local control of the tumor and as an adjunct to hormone therapy.

Those who should consider other treatments

Men whose cancer has spread to the lymph nodes or other parts of the body.

Side effects and complications of cryosurgery

The most common side effects are bladder or urethral irritation, causing such symptoms as frequent urination with little warning and burning, blood, or pain with urination. Irritation to the rectal wall may also occur. Penile or scrotal swelling occurs in about 50 percent of men; this is usually temporary.
Up to 80 percent of men have some level of erectile dysfunction after cryosurgery. The level depends on how aggressively the prostate tissues have been frozen.
One of the main risks of cryosurgery is the potential formation of a fistula — an abnormal connection between the urethra and rectum — and the possibility of not completely destroying the cancer cells.
In a 1997 study of the effects of cryosurgery, the most common serious complication was bladder outlet obstruction (a narrowing of the urethra at the bladder neck, obstructing the flow of urine). Transurethral resection of the prostate (TURP) was required to fix the problem in 23 percent of patients¹.
Rare complications include urethral scars causing such difficulty in urinating that a catheter is required.

Advantages of cryosurgery

Ease and quickness of the procedure
Short hospital stay and recuperation
Relatively inexpensive procedure
No serious problems with incontinence
Freedom from early side effects.

Disadvantages of cryosurgery

High rate of complications
Results of long-term studies of the effectiveness of cryosurgery are not yet available
The procedure may not be covered by your insurance. Several years ago, however, the Health Care Financing Administration approved reimbursement of cryosurgery for primary treatment of prostate cancer.
Some concerns that some cancer cells may escape freezing and proliferate.
Some concerns that other cells may be outside the prostate and will not be treated.

1 Aboseif S, Shinohara K, Borirakchanyavat S, Deirmenjian J, Carroll PR. The effect of cryosurgical ablation of the prostate on erectile function. Br J Urol 80(6):918-22.

The Prostate Cancer pages of this Web site are part of the Comprehensive Prostate Cancer Awareness Program (CPCAP), a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.

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Prostate Cancer

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Treatment
Cryosurgery