What is Cryotherapy for Prostate Cancer?
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.
Before Cryotherapy for Prostate Cancer
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 and Side effects
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
What are the advantages and disadvantages of Cryotherapy?
. Cryotherapy is less invasive than some other treatments, with little or no bleeding.
. You will only be in hospital for a day or overnight.
. Recovery is usually quick and most men return to their normal activities within a few weeks.
. You may be able to have cryotherapy if your cancer has come back after radiotherapy or brachytherapy.
. You may be able to have cryotherapy again if your cancer comes back after your first cryotherapy treatment. This isn't the case with all treatments.
. You may get side effects that might affect your daily life, such as erection and urinary problems.
. Compared with other treatments, we don't know as much about how well cryotherapy works or the risk of side effects in the long term (after 10 years).
Before your treatment
If your prostate is very large you may have hormone therapy for two to three months before you have cryotherapy. This can make the prostate smaller, and make the cancer easier to treat. As with all treatments, hormone therapy can cause side effects.
Your bowels need to be empty during cryotherapy so that your doctor can take clear scans of your prostate. So you might be given a laxative or an enema to empty your bowels before the treatment. An enema is a liquid that is put inside your back passage (rectum). You’ll also be asked not to eat for about six hours before the treatment, but will still be able to drink water up to four hours before the treatment.
During Cryotherapy for Prostate Cancer
Types of cryotherapy
There are two types of cryotherapy.
. Whole-prostate cryotherapy treats the whole prostate, including both the cancer cells and the healthy prostate tissue.
. Focal cryotherapy only treats the part of the prostate where the cancer is. It uses fewer needles, which means that less healthy tissue is frozen than in whole-prostate cryotherapy.
Focal cryotherapy isn’t suitable for all men. This will depend on the size of your cancer, and where it is in your prostate.
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
After your treatment
Most people can go home the same day or the following day. It’s normal to have some pain or discomfort. Your doctor or nurse will tell you which pain-relieving drugs you can take.
You’ll be given antibiotics to take for a few days, to lower your risk of infection. Contact your doctor or nurse if you have any signs of a urine infection, such as:
. A high temperature (fever)
. Feeling shivery
. A burning feeling when you urinate (pee)
. Dark, cloudy or strong-smelling urine
. Needing to urinate more often than usual.
You may be given drugs called alpha-blockers, such as tamsulosin or alfuzosin, to relax the muscle in and around your prostate to help you urinate. You may need to take them for a few weeks, or longer if you still have problems urinating. Alpha-blockers can cause side effects, so ask your doctor or nurse about these if you have any worries.
Cryotherapy usually causes the prostate to swell to begin with, which can make it difficult to urinate. You’ll go home with your catheter in place to drain urine from your bladder until the swelling has improved. Your urine will drain into a bag that you can empty. Or you might be offered a catheter valve instead of a bag. The valve fits on the end of the catheter tube and works like a tap. This means your urine will be stored in your bladder as usual. When you need to urinate, you can open the valve to empty your bladder. Your nurse will show you how to care for your catheter before you leave hospital.
Your catheter will usually be taken out at hospital one to two weeks after your cryotherapy treatment. This may feel uncomfortable. You’ll need to stay at the hospital for a few hours afterwards to check that you can urinate properly.
When the catheter is first removed, you may find that you leak urine. It’s a good idea to take spare underwear and trousers with you to the appointment. You can wear incontinence pads to absorb the urine – check if your hospital will provide these. If not, you can buy some at a pharmacy and take them with you to the appointment.
You may see some blood in your urine while the catheter is in place, and immediately after it’s taken out. This is normal. Drink plenty of fluids to help clear the blood. If you see signs of infection or lots of blood clots in your urine, speak to your doctor or nurse.
You might have some bruising and swelling around your testicles, buttocks and inner thighs for a few days after treatment. This can be worrying but is normal and will pass. It may help to wear tighter underwear for support. Holding an ice pack against the bruised and swollen area for 10 minutes every hour may help to reduce the swelling.
Your doctor or nurse may advise you not to stand for long periods of time for the first few weeks, as this can cause the prostate to swell more. You should be able to go back to your day-to-day activities as soon as you feel able to. But it may take a few weeks or months before you feel back to normal.
What happens afterwards?
You will have check-ups with your doctor or nurse at the hospital, including regular PSA tests. The PSA test is a blood test that measures the amount of a protein called prostate specific antigen (PSA) in your blood. It’s a good way to check how well the cryotherapy has worked. You may also have an MRI scan after treatment to check all your cancer has been treated.
How often you have check-ups will depend on your hospital, but you should have a PSA test about every three to six months for at least the first year, and every six months after that. Ask your doctor or nurse how often you’ll have PSA tests.
After cryotherapy, your PSA level should fall and then stay low. A continuous rise in your PSA level could be a sign that your cancer has come back. If this happens, your doctor may suggest you have further tests, such as an MRI scan or a prostate biopsy, to find out if it has.
If your cancer has come back, your doctor will talk to you about further treatment options. If cryotherapy was your first treatment, you may be offered more cryotherapy. Or they may offer radiotherapy or surgery. If you had cryotherapy as a second treatment following radiotherapy, you may be offered hormone therapy.
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.