Cryosurgery

Cryosurgery (also called cryotherapy or cryoablation) is sometimes used to treat localized prostate cancer by freezing it. As with brachytherapy, this may not be a good option for men with large prostate glands.

In this approach, several hollow probes (needles) are placed through the skin between the anus and scrotum (the perineum). The doctor guides them into the prostate using transrectal ultrasound (TRUS). Very cold gases are passed through the needles, creating ice balls that destroy the prostate gland. To be sure prostate tissue is destroyed without too much damage to nearby tissues, the doctor carefully watches the ultrasound images during the procedure. Warm saltwater is circulated through a catheter in the urethra to keep it from freezing. The catheter is kept in place for about 3 weeks after the procedure to allow the bladder to empty while the patient recovers. Spinal, epidural, or general anesthesia is used during the procedure.

After the procedure, there will be some bruising and soreness in the perineum where the probes were inserted. You may need to stay in the hospital for a day, but many patients leave the same day.

Cryosurgery is less invasive than radical prostatectomy, so there is usually less blood loss, a shorter hospital stay, shorter recovery period, and less pain than with surgery. But compared with surgery or radiation therapy, doctors know much less about the long-term effectiveness of cryosurgery. Current techniques using ultrasound guidance and precise temperature monitoring have only been available for a few years. Outcomes of long-term (10- to 15-year) follow-up must still be collected and reviewed. For this reason, most doctors do not often use cryotherapy as the first treatment of prostate cancer. It is sometimes recommended if the cancer has come back after other treatments.

Possible side effects of cryosurgery

Side effects from cryosurgery tend to be worse if it is done in men who have already had radiation therapy, as opposed to men who have it as the first form of treatment.

Most men have blood in their urine for a day or two after the procedure, as well as soreness in the area where the needles were placed. Swelling of the penis or scrotum is also common. The freezing may also affect the bladder and intestines, which can lead to pain, burning sensations, and the need to empty the bladder and bowels often. Most men recover normal bowel and bladder function over time.

Freezing damages nerves near the prostate and causes impotence in up to 80% of men who have cryosurgery. Erectile dysfunction is more common after cryosurgery than after radical prostatectomy (see above).

Urinary incontinence is rare in men who have cryosurgery as their first treatment for prostate cancer, but it is more common in men who have already had radiation therapy.

A fistula (an abnormal connection) between the rectum and bladder develops in less than 1% of men after cryosurgery. This rare but serious problem can allow urine to leak into the rectum and often requires surgery to repair.