Cryotherapy for prostate cancer

Cryotherapy (also called cryosurgery or cryoablation) is the use of very cold temperatures to freeze and kill prostate cancer cells. Despite it sometimes being called cryosurgery, it is not actually a type of surgery.

When is cryotherapy used?

Cryotherapy is sometimes used to treat early-stage prostate cancer. Most doctors do not use cryotherapy as the first treatment for prostate cancer, but it is sometimes an option if the cancer has come back after radiation therapy. As with brachytherapy, this may not be a good option for men with large prostate glands.

How is cryotherapy done?

This type of procedure requires spinal or epidural anesthesia (the lower half of your body is numbed) or general anesthesia (you are asleep).

The doctor uses transrectal ultrasound (TRUS) to guide several hollow probes (needles) through the skin between the anus and scrotum and into the prostate. Very cold gases are then passed through the needles to freeze and destroy the prostate. To be sure the prostate is destroyed without too much damage to nearby tissues, the doctor carefully watches the ultrasound during the procedure. Warm saltwater is circulated through a catheter in the urethra during the procedure to keep it from freezing. The catheter is left in place for several weeks afterward to allow the bladder to empty while you recover.

After the procedure, you might need to stay in the hospital overnight, but many patients leave the same day.

Cryotherapy is less invasive than surgery, so there is usually less blood loss, a shorter hospital stay, shorter recovery period, and less pain. But compared with surgery orradiation therapy, doctors know much less about the long-term effectiveness of cryotherapy. Cryotherapy doesn’t appear to be as good as radiation for more advanced prostate tumors.

Possible side effects of cryotherapy

Side effects from cryotherapy 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.

Freezing might also affect the bladder and rectum, 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 often damages the nerves near the prostate that control erections. Erectile dysfunction is more common after cryotherapy than after radical prostatectomy. For information on coping with erection problems and other sexuality issues, see Sexuality for the Man With Cancer.

Urinary incontinence (having problems controlling urine) is rare in men who have cryotherapy as their first treatment for prostate cancer, but it is more common in men who have already had radiation therapy.

After cryotherapy, less than 1% of men develop a fistula (an abnormal connection) between the rectum and bladder. This rare but serious problem can allow urine to leak into the rectum and often requires surgery to repair.