Cryosurgical Ablation Of The Prostate

What Is The Purpose Of The Prostate And Where Is It Found In Your Body

The prostate is part of the male reproductive system. Its main purpose is to produce fluid for semen, the milky fluid in which sperm swims. During an orgasm, the prostates muscles tighten to push the semen out of the penis.

The prostate is a gland about the size of a walnut that is under the bladder and in front of the rectum, or the lower end of the bowel. The urethra, or the thin tube that runs the length of the penis and carries both urine and semen out of the body, goes through the prostate.

What Can You Expect After A Cryoablation Of The Prostate

After the procedure, your doctor will insert a catheter, or a drainage tube, to help urine leave the body. This is because its usual for the prostate to be swollen for about seven days, making it hard for you to urinate. Your healthcare provider will remove the catheter at an office visit about seven days after the procedure. Then you will be able to urinate on your own.

What Are The Advantages And Disadvantages

What may be important for one person might not be important for someone else. If you’re thinking about having cryotherapy, speak to your doctor or nurse before deciding whether to have it they can help you choose the right treatment for you. Take time to think about whether you want to have cryotherapy. We’ve included a list of questions that you might find helpful. You can also ask about any other treatments that might be available.

Advantages

• Cryotherapy is less invasive than some other treatments, with little or no bleeding.
• You will only be in hospital for a day or overnight.
• Recovery is usually quick and most men return to their normal activities within a few weeks.
• You may be able to have cryotherapy if your cancer has come back after radiotherapy or brachytherapy.
• You may be able to have cryotherapy again if your cancer comes back after your first cryotherapy treatment. This isn’t the case with all treatments.

Disadvantages

• You may get side effects that might affect your daily life, such as erection and urinary problems.
• Compared with other treatments, we don’t know as much about how well cryotherapy works or the risk of side effects in the long term .
• You will usually need a general anaesthetic, so you’ll need to stay at the hospital for a day or overnight.
• Cryotherapy isn’t widely available in the UK.

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Why Choose Dr Bevan

Dr. Bevan-Thomas is a cryoablation expert and consultant for Endocare and has been educating other physicians around the country about how to perform cryoablation since 2004. He is often asked to fly to different cities and help other surgeons perfect their cryoablation technique to improve their results. He provides both primary and salvage cryotherapy.

Dr. B-T is also committed to thoroughly informing his patients about their diagnoses and treatment options. Because he offers more than one option for prostate cancer, he will help you make the best decision for your particular cancer. Treatment options include cryoablation, active surveillance, robotic surgery, and radiation therapy .

Make an appointment today to talk with Dr. Bevan-Thomas about the best way to treat your prostate cancer.

Cryotherapy For Local Control

Among patients undergoing repeat biopsy 3-24 months after treatment with a standard 5-probe cryotherapy system, 7.7-25% have been found to have residual malignancy of the glands, and 42-71% have been found to have focal areas of viable benign epithelium. Numerous disease- and treatment-related factors have been shown to predict rates of local control.

In one series, for example, the likelihood of positive biopsy findings was 9% in subjects with clinical stage T1 or T2 disease, compared with 21% in those with T3 disease. Persistent or recurrent cancer is more likely among tumors located in the prostatic apex or the seminal vesicles than those located in the midgland or the base.

A pooled analysis stratified patients into the following risk groups :

• Low risk – PSA level of 10 ng/mL or lower, Gleason score of 6 or less, and clinical stage T1 or T2a disease

• Intermediate risk – PSA level higher than 10 ng/mL, Gleason score of 7 or more, or clinical stage T2b disease or higher

• High risk – The presence of 2 or 3 of these adverse risk factors

The distribution of patients among low-, intermediate-, and high-risk groups was 25%, 34%, and 41%, respectively. The positive biopsy rate in the series was 18% overall: 12% among low- and intermediate-risk patients and 24% among high-risk patients.

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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.

What Is The Follow

After three months, you will have a follow-up visit with your healthcare provider. At this time, youll have a PSA test, a blood test that checks for prostate-specific antigen, or PSA, a protein produced by the prostate gland. The PSA test is done to make sure that the treatment worked.

Your healthcare provider will monitor you and suggest a follow-up plan depending on the stage of the cancer and the potential for it to return.

A note from Cleveland Clinic

If youve been treated for prostate cancer and it has come back, your healthcare provider might suggest that you have a salvage cryoablation. Its important to have an honest discussion of the risks and benefits of the procedure and a good understanding of what to expect. Please make sure to ask questions about whatever concerns you. The goal is for you to be able to live longer and live well.

Last reviewed by a Cleveland Clinic medical professional on 08/27/2020.

References

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Who Should Consider Cryotherapy

Cryotherapy is an option for men with localized or locally advanced prostate cancer, where the tumor has only extended out of one side of the prostate . It may be used as an alternative to surgery, particularly for men who do not qualify for surgery for various reasons. Use of cryotherapy is approved for all grades of localized prostate cancer, from low and intermediate risk to high risk.

This treatment can be used alongside other standard treatments for localized prostate cancer. Cryotherapy is also an option for men who experience a recurrence following radiation therapy .

There is some evidence that cryotherapy may be a cheaper option that other treatments for localized prostate cancer.

What Are The Benefits Of Salvage Prostate Cryoablation

One benefit of salvage cryoablation of the prostate is that it is a minimally invasive procedure. Many times it does not require a hospital stay. Everyone is different, but you will probably be able to resume normal activity within the first week following the procedure.

Other benefits include:

• Short recovery period.
• Minimal anesthesia.

Salvage cryoablation of the prostate offers another treatment option to men who have failed radiation treatment. In addition, it can be repeated if the first treatment did not completely kill the cancer.

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What Does Cryotherapy Involve

Each hospital does things differently. We’ve included some general information about what might happen. Your doctor or nurse will give you more information about what will happen before, during and after your treatment.

Before your treatment

If your prostate is very large you may have hormone therapy for two to three months before you have cryotherapy. This can make the prostate smaller, and make the cancer easier to treat. As with all treatments, hormone therapy can cause side effects.

Your bowels need to be empty during cryotherapy so that your doctor can take clear scans of your prostate. So you might be given a laxative or an enema to empty your bowels before the treatment. An enema is a liquid that is put inside your back passage . Youll also be asked not to eat for about six hours before the treatment, but will still be able to drink water up to four hours before the treatment.

During your treatment

Cryotherapy is usually done under general anaesthetic so that youre asleep and wont feel anything. If you cant have a general anaesthetic for health reasons, you may be able to have a spinal anaesthetic, so that you cant feel anything in your lower body.

Your surgeon will pass a tube called a warming catheter up your penis and into your bladder. Warm liquid is passed through the catheter during the treatment so that your urethra and the wall of your back passage do not freeze.

After your treatment

What happens afterwards?

Relative Contraindications For Csap

The largest group of patients who are not good candidates for CSAP is comprised of patients who have undergone prior transurethral resection of the prostate . The sloughing rate in these patients is higher than in nonresected patients, in part because of the inability to adequately warm the urethral lumen. Coaptation of the warming catheter to urethral mucosa is not complete because of the luminal defect created by the TURP.

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What Is Cryotherapy For Prostate Cancer

The prostate gland is found only in males. It sits below the bladder and wraps around the urethra, the tube that carries urine out of the body. The prostate helps make semen.

Cryotherapy involves freezing the cancer cells and cutting off their blood supply. Tiny needles are placed right into the tumor. Argon gases are passed through the needles and exchanged with helium gases. This causes a freezing and warming cycle. The frozen, dead tissue then thaws and is naturally absorbed by the body.

Cryotherapy can be used to treat a variety of problems. When used to treat prostate cancer, a warming catheter is put into the urethra to keep it from freezing. The needles are guided into the prostate tumors using ultrasound imagery to guide them.

Where Can I Learn More

To learn more about cryotherapy, to view a video of doctors, patients and their spouses. The video is provided by Healthtronics and is not affiliated with ZERO The End of Prostate Cancer. This video is provided as an educational resource not an endorsement of treatment.

To learn more about localized disease, go to our Localized Cancer section.

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What Are The Complications Of Salvage Prostate Cryoablation

Recent medical and technical advances have shown a steady decline of side effects from salvage prostate cryoablation. As it is a salvage procedure and a last chance to get rid of the cancer for many men, it is somewhat common that you might have problems with erectile dysfunction, or not being able to keep an erection during sex. This can be treated with medication. Otherwise, side effects are very rare .

You might experience these types of complications:

• Swelling of the scrotum.
• Urinary urgency and increased urinary frequency.
• Pelvic or rectal pain.

Rarely, the procedure may also risk injury to surrounding tissues such as the rectum or bladder because of the nearby location of these structures.

Another rare complication is the potential for the patient to develop a fistula, an abnormal opening that connects the urethra and the rectum. The fistula may cause the patient to have diarrhea from urine in the rectum. It may also cause infection from bacteria in the bladder.

What Is Salvage Prostate Cryoablation

Salvage cryoablation of the prostate is a procedure recommended for prostate cancer that has returned in men who have been treated previously.

Salvage literally means save. The doctor is trying to save the patient from the cancer. The procedure uses cryoablation, or extreme cold, to freeze the prostate, so that the cancer cells within it will freeze and die. It is also called cryosurgery or cryotherapy.

The procedure is typically done on an outpatient basis and is minimally invasive.

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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.

Questions To Ask Your Doctor Or Nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

• Where is this treatment available?
• What are my other treatment options?
• Will I have focal or whole-prostate cryotherapy?
• What are the side effects of cryotherapy, how likely am I to get them, and how can they be managed?
• How much experience do you have in carrying out cryotherapy? Can I see the results of treatments you’ve carried out?
• How often will you check my PSA level after the treatment?
• How will we know if the treatment has worked?
• How likely is it that I’ll need more treatment after cryotherapy?
• What treatments are available after cryotherapy?

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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.

Mechanism Of Tissue Injury And Cell Death In Cryoablation

Cryoablation causes cell damage through a drop in temperature that causes freezing. The aim of cryoablation is to cause destruction of the tumor by creating overlapping cryoablation zones to encompass the entire volume of tumor, while minimizing collateral damage to surrounding normal tissues. Various studies have looked at the minimum temperature required to achieve destruction of tumors, and the mechanisms of injury, importance of cooling rates, and time of contact, as well as the effect of freezethaw cycles.

In their review, Cooper summarized five mechanisms that are responsible for tissue destruction: dehydration and change in electrolyte concentration due to removal of water from solution, crystallization with rupture of cellular membranes, permanent change in the protein molecules of the cell membrane causing irreversible loss of semipermeability, thermal shock, and vascular stasis and coagulation .

A general consensus exists that temperatures of 40°C, have been shown to cause adequate cell destruction. The mechanism of cell death is different at different freezing rates: at rapid freeze rates of over 25°C per minute it is due to rapid intracellular ice formation, but at slower freeze rates of less than 5°C per minute, changes in the chemical composition of the cells were the main mechanism of cell death .

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Why Might I Need Cryotherapy For Prostate Cancer

Cryotherapy may be a good treatment option for prostate cancer treatment in the following situations:

• Men with cancer in the prostate gland that hasnt spread to other parts of the body

• Men who arent well enough to get radiation or procedure

• When the goal isnt to cure, it may be useful for men who have cancer that has spread beyond the prostate gland and need treatment for symptoms

• Sometimes its used for men who have had unsuccessful results with radiation therapy

Some experts believe cryotherapy can be helpful when the prostate cancer cells arent as sensitive to radiation.

Cryotherapy may not be recommended for men who have a very large prostate gland.

Cryotherapy is less invasive than standard procedure. It involves needles that are put in through the skin under the scrotum, called the perineum. There is less blood loss, a shorter hospital stay, faster recovery, and less pain. It can be repeated, if needed.

There may be other reasons for your healthcare provider to recommend cryotherapy.