How Is Cryotherapy Done
This type of procedure requires spinal or epidural anesthesia or general anesthesia .
The doctor uses transrectal ultrasound to guide several hollow probes 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 passed 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 men go home 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 or radiation therapy, doctors know much less about the long-term effectiveness of cryotherapy. And as with brachytherapy, this may not be a good option for men with large prostate glands.
Will I Need A Catheter After The Cryoablation Procedure
Yes. A suprapubic catheter will be placed during the operative procedure. A urethral catheter will not be needed. You will need to keep the suprapubic catheter on drainage to a bag for several days, and then begin clamping it off. When swelling in the treated gland subsides sufficiently to allow you to urinate through the urethra, the suprapubic tube will be removed. This is done on your return visit to the office, usually about one week after the procedure.
What Happens During The Salvage Cryoablation Of The Prostate Procedure
Cryoablation of the prostate exposes the entire prostate gland to a temperature of -40° C or lower in order to kill cancer cells. The procedure pinpoints the prostate while avoiding the surrounding body parts, such as the rectum, in order to minimize damage to those other parts.
The procedure is done under general anesthesia, so you will be asleep.
The doctor inserts several cryoprobes, or thin, hollow needles, though the perineum and into the prostate. To guide the needles to the prostate, the doctor watches an ultrasound, equipment that projects a picture of the inside of the body onto a screen. The needles carry argon gas, a freezing agent to the prostate. When the needles reach the prostate, the gas is released and freezes and kills the prostate cells and any tumors within the area.
Also Check: Preparation For Prostate Mri Scan
Will I Need Help At Home After Cryoablation
Generally yes, but not skilled nursing assistance. How much help you may need is very dependent on your level of functioning before the procedure. You may need some assistance the first few days since this is outpatient surgery and you will need to take a number of oral medications on schedule, as well as manage your urine drainage bag. You should not have a lot of pain or discomfort, and will be able to ambulate before you leave the hospital on the day of your procedure.
What Is The Difference Between Salvage Cryoablation Of The Prostate And Other Treatment Options For Prostate Cancer
Salvage prostate cryoablation, when used on the whole gland, destroys all of the prostate tissue. Other treatments do the following:
- Radiation therapykills the individual cells. The more aggressive the cancer, the harder the cells are to kill with radiation.
- Radical prostatectomy, or surgery to remove the entire prostate and some of the surrounding tissue, is sometimes done after failed radiation therapy. It has a risk of significant complications, such as incontinence and erectile dysfunction.
- Hormonal therapy, to reduce the level of male hormones, is another option and may be recommended to reduce tumor size and slow the cancer growth. It will not cure the cancer and has significant side effects.
Recommended Reading: Brca Gene And Prostate Cancer
How Will I Know That The Treatment Has Been Successful
As with any other prostate cancer treatment option, the postoperative PSA blood test will be the primary indicator of a successful treatment. We will obtain a PSA level three months after the procedure, and then every six months for five years. After five years PSA monitoring is generally done annually. We expect to see the PSA come down to a level well below 0.5 ng/dl and remain at the lowest level achieved. Three successive rises in the PSA after reaching the lowest point would raise concern about residual or recurrent prostate cancer.
Cryoablation For Prostate Cancer
Prostate cancer is one of the most common forms of cancer in men and some of its traditional treatments can result in serious complications. However, cryoablation is an emerging alternative therapy for prostate cancer that shows great promise. Due to recent advances with smaller needles and computer guided programs to insert the needles, the procedure has become much more effective and offers patients an outpatient treatment with minimal side effects. What does this new treatment entail? What are its advantages and disadvantages? The following information should help answer those questions and more.
Cryoablation In Clinical Practice
The original indication for cryoablation of the prostate was for salvage therapy in prostate cancer patients who had recurred after either external beam radiotherapy or brachytherapy. However, now prostate cryotherapy is also indicated for primary treatment of prostate cancer. As described in the Prostate Cancer section of this site, Dr. Engel does not feel cryotherapy to be appropriate for all cases of prostate cancer. A typical patient is an older patient, particularly one with voiding symptoms that prohibit the safe application of radiation. Other indications would include lower risk cancers, and in patients with morbidities that would make surgery exceedingly risky.
Risks Of Prostate Cryoablation
Complications of cryoablation of the prostate are generally local, and can rarely include urethral sloughing leading to blood in the urine and urinary burning, very rare incontinence, infection, penile numbness, and erectile dysfunction. The incidence of incontinence is 1-2% in primary cases, and slightly higher in radiation salvage cases.
What Are The Side Effects
Like all treatments, cryotherapy can cause side effects. These will affect each man differently and you may not get all of them.
The most common side effects of cryotherapy are erection and urinary problems.
Many of the side effects of cryotherapy are caused by healthy tissues being frozen and damaged. Side effects are more likely if you have already had radiotherapy or brachytherapy to your prostate. This is because they may have already damaged the area around your prostate.
Focal cryotherapy can cause the same side effects as whole-prostate cryotherapy. But some research suggests focal cryotherapy may cause less severe side effects, because a smaller area of the prostate is damaged than with whole-prostate cryotherapy.
Ask your doctor or nurse for more information about your risk of side effects. They may be able to show you results of treatments they’ve carried out and put you in touch with other men who’ve had cryotherapy.
The most common long-term side effect of cryotherapy is difficulty getting or keeping an erection . More than three quarters of men cant get an erection after whole-prostate cryotherapy. This is because the treatment can damage the nerves that control erections. Studies suggest that more men get their erections back after focal cryotherapy, because less healthy tissue is damaged than with whole-prostate cryotherapy.
Some men find these problems improve with time, but not all men get their erections back. There are treatments that can help.
Are There Advantages To Using Cryotherapy For Prostate Cancer
There are few long-term studies on cryotherapy and prostate cancer. Some experts believe, though, that cryotherapy offers several advantages over surgery and radiation. Those advantages may be particularly noticeable in early-stage prostate cancer. For instance, cryotherapy is a less invasive procedure. It can be done using an epidural or spinal instead of general anesthesia. This may benefit older men with prostate cancer. It can also benefit men who have other conditions such as diabetes, heart disease, or lung disease.
Other advantages with cryotherapy include:
- Shorter hospital stay
- Shorter recovery period
- Much less swelling and pain than with standard surgery for prostate cancer
If needed, cryotherapy can be followed with other conventional therapies, such as radiation therapy or surgery.
One recent study followed men with prostate cancer for a period of 10 years. In that study, researchers concluded that cryotherapy might be as effective as radiation and other common treatments for prostate cancer. Cryotherapy, though, wasn’t directly tested against those more established treatments.
Hemigland Cryoablation For Localized Prostate Cancer: Outcomes At 5 Years
According to research published in The Journal of Urology, the 5-year treatment-free survival of patients with localized prostate cancer who underwent hemigland cryoablation was 85%, with higher rates in those with low-risk disease and lower rates in those with high-risk disease . Hemigland cryoablation of localized prostate cancer provides effective midterm oncologic outcomes with good continence and potency, concluded Andre Luis Abreu, MD, of the University of Southern California, and colleagues.
The study included 160 consecutive cases of men with localized prostate cancer and a median age of 67 years who were treated with hemigland cryoablation . The baseline prostate-specific antigen level among participants was 6.3 ng/mL, and the majority of patients had intermediate-risk or high-risk disease.
At a follow-up of 5 years, the clinically significant disease-free survival rate was 89%, and the treatment failurefree survival rate was 85%. The rate of biochemical failurefree survival was lower, at 62%. At 5 years out, no patient had metastatic disease.
Given the limitations of this study, hemigland cryoablation should be performed with caution and in carefully selected patients, especially in those with high-risk prostate cancer, Dr. Abreu and colleagues concluded. Additional data from prospective trials with large and multicenter cohorts are necessary to validate our reported findings.
Disclosure: The study authors reported no conflicts of interest.
Results Of Prostate Cryoablation
The PSA will rise sharply during the immediate post freeze period, and should not be checked. This elevation is thought to be due to the release of intracellular PSA at the time of cell destruction. The PSA will usually get to its lowest point at 3-6 months. Ideally, the nadir will be < 0.4. In one 7-year study, the biochemical disease free survival rate for low grade, intermediate, and high grade prostate cancers, was 61%, 68% and 61%. When the PSA nadir point was placed at < 1.0 the rates were 87%, 79%, and 71%.
To determine if you are a candidate for cryoablation, or to discuss anything at all about prostate cancer, call and arrange a consultation with Dr. Engel. Dr. Engel takes pride in realizing that one size does not fit all. We are able to offer all of the latest treatments for prostate cancer, and will attempt to help you decide what is best for you based on your age, stage and grade of prostate cancer, as well as your other medical problems.
How Does Cryotherapy Work
Ultrasound is used to guide special needles, called cryoprobes, into the prostate. Argon gas is placed in the needles and creates an ice ball that kills cells in the area near the frozen probe. Once the prostate has been frozen and the procedure completed the probes are removed from the body.
Cryotherapy destroys any tissue that it touches, both cancerous and healthy. Close monitoring lowers the risk of damaging nearby healthy tissue. To preserve the urethra, a warming catheter is used to keep the urethra warm during the procedure and for a brief time after the last freezing. The urethra is the tube that takes urine from your bladder to outside the body.
This is usually a one-time procedure done in a few hours in a specialists office, under either spinal or general anesthesia.
Siu 201: Focal Cryoablation For Prostate Cancer
Athens, Greece Cryoablation involves freezing of the targeted prostate tissue in two cycles, reaching minus 40 degrees Celsius, with the following histological changes:
Ten-year data of whole-gland cryoablation in 370 patients with a follow-up of 12.55 years have shown a biochemical disease-free survival rate at 10 years of 80.56%, 74.16%, 45.54% for low-, intermediate-, and high-risk disease, respectively.1 The 10-year negative biopsy rate was 76.96%. These patients maintain relatively high continence and potency rates compared to radical definitive therapies.
Patient selection is critical to achieving a high success rate in focal therapy. The ideal patient is a patient who has a disease which is between Gleason grade group 1 and 2, who is not an ideal candidate for active surveillance, such as a patient with Gleason grade group 1 with multiple positive cores, with a high percentage of core involvement, and a high PSA density. A patient with low volume Gleason grade 2 who desires to undergo this treatment is also a good candidate.
References:
Benefits And Risks Of Cryotherapy
There isnt much information about the long-term effectiveness of cryotherapy, but it is known to be less effective than radiation therapy. However, the cryotherapy is able to freeze and kill the cancer cells in the prostate. It is particularly indicated as primary treatment in cases of early-stage cancer confined to the prostate or as salvage therapy, after other cancer treatment to stop the growth of recurrent prostate cancer. The side effects of the treatment are usually worse in patients who previously underwent radiation therapy. Patients often experience soreness, swelling of the penis or scrotum and blood in urine right after the procedure.
Freezing often damages the nerves near the prostate that control erections. Erectile dysfunction is more common after cryosurgery than after radical prostatectomy, the Cancer Society states. 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.
Salvage Therapy After Failure Of Cryoablation
We recently analyzed our cryoablation series to examine the results of secondary or adjuvant treatments in 38 patients with positive follow-up biopsies. Eight patients were lost to follow-up, and among the remaining 30, additional treatments included salvage radical retropubic prostatectomy , salvage radiotherapy , endocrine therapy , repeat cryotherapy , and observation . We were particularly interested in the 10 patients who underwent salvage surgery or radiation therapy.
As expected, residual prostate cancer was found in all four who underwent salvage retropubic prostatectomy. Significantly, three of the four also had periprostatic and seminal vesicle invasion. Two of the four patients continue to be free of disease with undetectable PSA levels. The other two are on endocrine therapy for their progressive local and metastatic nodal disease.
Of the six patients undergoing salvage external beam irradiation for cryotherapy failure, five are reported to be free of recurrent disease based on digital rectal examinataion and undetectable PSA levels. The remaining patient has been lost to follow-up.
Inclusion And Exclusion Criteria
All available randomized controlled trials and controlled studies which had compared primary or salvage CS with RT or RP in patients with clinically localized PCa were included in the review. In addition, materials reporting results of CS in single-arm trials were also reviewed systematically. To supplement these data, the related reference lists from identified documents were also acquired, and all computer searches were supplemented with a manual search. When multiple reports described the same population, the most comprehensive or recent was used.
Patients with organ metastasis were excluded. Because of the possibly unavoidable replication with small-scale studies, patients from registered databases were excluded from meta-analysis but were included in the . Finally, data from conference abstracts, papers that were not extractable or whose data were not available for our analyses were also disregarded.
Comparing The Oncological Outcomes Of Cryoablation Vs Radical Prostatectomy In Low
- 1Department of Urology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Science, Beijing, China
- 2Graduate School of Peking Union Medical College, Beijing, China
Purpose: To compare the oncologic outcomes of cryoablation and radical prostatectomy in patients with low- and intermediate-risk localized prostate cancer .
Materials and Methods: PCa patients who received CA or RP between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable Cox proportional hazard analysis was used to compare the prostate cancer-specific survival and overall survival . We conducted 1:3 propensity score matching and adjusted standardized mortality ratio weighting to balance the clinicopathological characteristics.
Results: Ninety-seven thousand seven hundred eighty-three patients were identified after preliminary screening. After matching, the CA and RP groups included 1,942 and 5,826 patients and had median follow-up periods of 85 and 72 months, respectively. CA had lower CSS and OS rates than did RP, which was consistent in the SMRW model . The 10-years CSS and OS for CA vs. RP were 98.1 vs. 99.2% and 61.3 vs. 79.9%, respectively.
Experience At The University Of California San Diego
At the University of California, San Diego Medical Center since March 1993, 296 men with prostate cancer have been treated with prostate cryoablation in a total of 316 procedures. Their clinical stages included T1 to T4, NO to N1, and MO to M1. Their average age was 68 years. Five cryoprobes were used in the cryoablation in 80% of cases. Most men voided spontaneously with removal of the suprapubic cystostomy tube by 10 to 14 days. Of the 137 men who had a follow-up biopsy at 1 year or later, 110 had cumulative negative biopsies, and 27 had persistent cancer documented by a positive biopsy.
Patients with persistently elevated or rising PSA levels, with or without abnormal findings on digital rectal examination, are more likely to undergo follow-up biopsy. Conversely, patients doing well clinically with low or undetectable PSA levels and negative findings on digital rectal examination are less likely to require follow-up biopsy.
At the 1-year follow-up, of 63 patients biopsied, 48 were negative and 15 were positive for malignancy. Of 52 patients biopsied between 2 and 3 years after cryoablation, 42 were negative and 10 were positive. Finally, of 22 men with follow-up biopsies at 3 years or later, 20 were negative and 2 were positive.