Prostate cryotherapy

Overview

Prostate cryotherapy, often referred to simply as prostate cryoablation or cryosurgery, is a medical procedure designed to eliminate cancer cells in the prostate by freezing them using argon gas. During this procedure, needles are inserted to target and freeze the tumor.

Healthcare providers, typically urologic surgeons, can use this treatment to address the entire prostate or just a portion of it. It is commonly utilized when cancer recurs after radiation therapy, but it can also be considered as an initial treatment option for some patients. Common side effects of prostate cryoablation include erectile dysfunction and urinary incontinence.

Reasons for undergoing the procedure

Prostate cryotherapy is typically used for treating prostate cancer that is localized, slow-growing, and has a low risk of spreading.

You may be considered for this treatment if you prefer to avoid surgery or radiation, if your healthcare provider recommends against these options, or if the cancer has recurred after previous radiation therapy. Additionally, cryotherapy might be considered if you are seeking relief from pain or other symptoms related to the cancer.

Risks

The most common risks associated with prostate cryotherapy include erectile dysfunction (difficulty achieving an erection) and urinary incontinence (leaking urine). These risks are heightened for individuals who have previously undergone other prostate treatments, such as radiation therapy. Many patients notice significant improvement in these issues within 12 to 18 months following the procedure.

Other potential risks may include:

• Swelling in the scrotum
• Pain or a burning sensation during urination
• Pain in the pelvic area or rectum
• Blood in the urine
• Increased urgency or frequency of urination

While serious complications are rare, they can occur and may involve:

• Injury to surrounding tissues, including the rectum or bladder
• Formation of a fistula, which is an abnormal connection between the urethra and rectum.

Procedure

During prostate cryotherapy, tumor cells are frozen to a temperature of around -40 degrees Celsius using argon gas, which ultimately results in their elimination. To apply the gas, a healthcare provider inserts needles, called cryoprobes, straight into the tumor during the process. To guide the needles and monitor the effectiveness of the ice ball formation around the tumor, a transrectal ultrasonography is used.

After the ice ball is formed, helium gas is applied to thaw the cells. This initial freeze-thaw cycle weakens the cells, and the provider conducts at least one more freeze-thaw cycle to ensure the cells are destroyed.

Before the procedure

You will receive detailed instructions from your healthcare provider on how to be ready for the treatment, and paying strict attention to these instructions can help lower the likelihood of complications. Prior to receiving prostate cryotherapy you might have to:

• Fast for eight hours before the procedure (avoid eating and drinking).
• Take a laxative to ensure your colon is clear.
• Arrange for a friend or family member to drive you home afterward.

Additionally, make sure to inform your healthcare provider about all the medications you are taking, including any over-the-counter or herbal supplements.

During the procedure

The healthcare provider will conduct the following steps for prostate cryotherapy:

• Administer anesthesia, which may be either general or local, depending on the specifics of your case
• A catheter is inserted into your urethra, the passage through which urine exits your body. Warm saline flows through the catheter to protect your urethra from freezing and to keep it open, allowing urine to drain during and after the procedure.
• Place several needles at precise locations within the prostate, guided by imaging techniques such as transurethral ultrasound or MRI.
• Use argon gas through the needles to freeze the tumor, monitoring the formation of the ice ball over a few minutes.
• Introduce helium gas through the needles to thaw the tumor.
• Repeat the freeze-thaw cycle at least once more to ensure thorough treatment.

The procedure typically lasts about 45 minutes, but you may spend two to three hours at the healthcare provider’s office or hospital if the procedure is done on an outpatient basis.

After the procedure

After the surgery, your healthcare provider will keep an eye on your recovery and let you know when it’s safe to return home. You may on occasion need to spend the night in the hospital to be observed. Your provider will keep the catheter in place for one to two weeks and may prescribe an antibiotic to help prevent infections.

Outcome

Prostate cryotherapy offers several benefits, including:

• It is minimally invasive.
• It typically does not require an overnight stay in the hospital.
• It uses only a small amount of anesthesia.
• Recovery time is generally brief.
• The risk of complications is low, which can improve your overall quality of life.
• If necessary, the procedure can be repeated to ensure the cancer is fully treated.
• It serves as an alternative to surgical options or radiation therapy and can be used if other treatments are unsuccessful.

While individual recovery experiences may vary, most patients find they need about a week to recover from prostate cryosurgery. A catheter is usually removed within one to two weeks. Consult your healthcare provider to determine when it is safe to resume your usual activities.

Providers evaluate the effectiveness of the procedure by monitoring several factors:

• The time until prostate-specific antigen (PSA) levels rise.
• The growth of the tumor.
• The necessity to switch to a different treatment method.

Research indicates that prostate cryotherapy is effective for approximately 76% to 90% of patients three years following the procedure.

If you have any questions before or after the procedure, be sure to reach out to your healthcare provider. Notify them immediately if you experience symptoms of infection, such as fever or urine that is bloody, cloudy, or has an unpleasant odor, or if you experience any pain.