Cryotherapy for Prostate Cancer Treatment

Cryotherapy, also known as cryosurgery or cryoablation, is a medical procedure that uses extremely cold temperatures to deaden and destroy tissues. Cryotherapy can be used to treat a variety of conditions, including prostate cancer. When used to treat prostate cancer, cryotherapy involves freezing tissue in the prostate, causing cancer cells to die. It can also be used as an alternative to surgical removal of the prostate gland itself.

Also called cryosurgery, cryotherapy actually is not a type of surgery—it’s a minimally invasive procedure. There are some side effects possible, but technological advances have limited many of these side effects.

Reasons for Cryotherapy

There are two typical situations where cryotherapy might be used as treatment for prostate cancer:

• Primary treatment: In some cases, usually early-stage cancer that’s limited only to the prostate, cryotherapy will be used as the primary treatment.
Returning treatment: Your doctor may use cryotherapy after another treatment, such as radiation therapy, has been completed, but cancer has returned to the prostate.

There are a few situations where cryotherapy might not be right for men with prostate cancer:

Men with normal sexual function—many men experience long-term sexual dysfunction after cryotherapy
Men who previously had surgery for rectal or anal cancer
Men whose prostates cannot be monitored by an ultrasound probe during the procedure.
Men with enlarged prostate glands
Men with large tumors that can’t be treated without damaging other tissues and organs, including the rectum or bladder

Possible Side Effects

Side effects of cryotherapy for prostate cancer can often be worse in men who have had previous radiation therapy. Side effects include:

Blood in urine
Erectile dysfunction
Pain and swelling of the scrotum and penis, or at the area where needles were placed
Loss of bladder control (bladder function normally returns over time)
Frequent, difficult or painful urination
Bleeding or infection at treated area

Slightly rarer side effects include:

Urinary incontinence: Trouble controlling urine is rarer for men using cryotherapy as their primary treatment, but more common for men who have undergone radiation therapy.
Fistula: An abnormal connection between the rectum and bladder, allowing urine to leak into the rectum and often requiring surgery. This occurs in under 1 percent of cases.
Blockage of the urethra (tube that carries urine out of the body).
Infection or inflammation of the pubic bone.
Injury to the rectum.

Preparation and Expectations

Preparation for cryotherapy is simple. Your doctor might recommend an enema, a fluid solution to empty the colon before the procedure. You also might receive an antibiotic to prevent infection.

Before your procedure, you’ll be given a spinal or epidural anesthesia (numbs the lower half of the body) or general anesthesia (you go to sleep). From here, several steps will take place:

Ultrasound probe is placed in your rectum.
Catheter (tube) is placed in the urethra, and filled with a warming solution (warm saltwater) to keep the urethra from freezing.
Several thin metal probes or needles are inserted in the area between the scrotum and the anus into the prostate. Needles are guided and placed using the ultrasound probe.
Argon gas is released through the pins or needles, cooling them and freezing tissue nearby. The doctor controls these temperatures.
A catheter may be placed in your bladder to assist in draining urine.

Results and Aftermath

After a cryotherapy procedure, you may have to spend a night in the hospital, though you’re likely to be able to go home the day of the procedure. The catheter in your bladder is often left in place for a couple weeks to allow the bladder to empty during recovery. You may be given an antibiotic to prevent infection. Blood loss for prostate cancer is much less significant than typical surgery, as is your typical hospital stay, recovery period and pain level.

A few after-effects you may see following your procedure include:

Soreness and bruising where rods were inserted, often for several days
Blood in the urine for several days
Trouble emptying the bladder and bowels (usually resolves itself over time)
Sexual dysfunction or impotence

You’ll receive regular follow-up exams, periodic imaging scans and lab testing after your procedure to determine the cancer’s response to treatment. Because this procedure has only been in use for a period of several years, long-term outcomes are currently not known.

If you have questions about cryotherapy or want to investigate it as a possible option, speak to your doctor and they will determine the most appropriate course of treatment.

I practice the full range of family medicine including obstetrics, pediatrics, adolescent medicine and adult medicine. I also practice some orthopedics, remove lumps and bumps, and perform colposcopy, cryotherapy and vasectomies. Due to the volume of deliveries we do, my practice has evolved to be more centered on women and children’s medicine, but I enjoy all aspects of family medicine.