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Focal Cryotherapy For Prostate Cancer

Cryotherapy Treatment For Prostate Cancer

MRI-Ultrasound Fusion Guided Focal Cryotherapy of Prostate Cancer at Weill Cornell Urology

The common diagnosis of prostate cancer in men has led to in-depth research and the development of a variety of treatment options. Treatments vary by the severity of the diagnosis and the specific needs of the patient. Cryotherapy treatment for prostate cancer is a non-surgical treatment that can provide treatment to some patients diagnosed with prostate cancer.

As a urologists office in Miami, we feel that providing information onprostate cancer treatments can help individuals make informed decisions about their future. As prostate cancer is one of the most commonly diagnosed cancers in men, we always recommend regular prostate exams for early detection and treatment.

The Aim Minimum Invasion And Maximum Precision

The modern approach in prostate cancer care is to avoid resection of the entire gland, in order to decrease the risks of urination disturbances and erectile disorders associated therewith. Recently, new medical technology has been added to the surgical armamentarium which enables treating the cancerous cells only, without affecting the integrity of the gland.

The possibility to treat the prostate by cryotherapy in a targeted manner evolved due to two different developments:

  • The transition from a superficial prostatic biopsy to fusion biopsy, which shows the urologist the exact location of the tumor within the gland.
  • The development of third-generation cryotherapy devices, which use noble gases, namely argon and helium, which enable the application of small transducers having a size of a thin needle.

Frequently Asked Questions About Prostate Cancer Treatment And Targeted Cryotherapy

What is prostate cancer?

Prostate cancer is a condition in which malignant cells form in the prostate, one of the male reproductive glands. These cells form a lump or mass called a tumor that can grow directly through the prostate gland and spread cancer cells to surrounding tissue, including the rectum and bladder. This year, over 220,000 new cases are expected to be diagnosed with prostate cancer, or one out of every six men. An estimated 28,900 American men will die of this disease.

How is prostate cancer treated?

Several options are available to treat prostate cancer. Because some men have aggressive forms of prostate cancer, while others have slow-growing cancer, patients should consult their physician to determine which treatment is most effective for the particular stage of their disease. Ideally, the treatment sought for prostate cancer should cure the disease, be easily tolerated and cause minimal problems for the patient for the remainder of his life.

Current treatment options for localized prostate cancer include targeted cryotherapy , radical prostatectomy, external beam radiation and internal radiation implants . While radical prostatectomy is the gold standard for treatment of prostate cancer, many men are considering less invasive treatment options that show equal success, involve faster recovery, less severe side effects and fewer complications.

How does targeted cryotherapy treat prostate cancer?

How does the physician monitor the freezing process?

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Is Cryotherapy Used Instead Of Surgery Or Radiotherapy For The Treatment Of Prostate Cancer

In patients who are advised to have an active form of treatment because the cancer would otherwise progress or grow if they didnt have treatment can have cryotherapy provided the cancer is limited to one or two areas within the prostate. It is also important that the prostate cancer has not shown any signs of distant spread or what is called metastases. The vast majority of patients who were diagnosed with prostate cancer that has shown no sign of spread are offered whole-gland radical radiotherapy or prostatectomy surgery which involves removing the entire prostate. These treatments are very effective and are known to improve cancer control and survival in the long term but that cancer control and survival in the long term in the majority of cases is a small benefit over monitoring the cancer.

Cryotherapy treatment for prostate cancer is therefore an alternative in those patients that are eligible, instead of whole-gland radical surgery or radiotherapy. It is not for every single patient who is diagnosed with prostate cancer and the detailed eligibility criteria are discussed below although a detailed discussion of your circumstances is very important with an expert in focal therapy. Doctors who do not carry out focal therapy can sometimes mistakenly state patients under their care are no eligible when they so always ask to speak to or see a focal cryotherapy specialist.

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Focal Therapy For Prostate Cancer

MRI

Video Transcript

Some men with early stage prostate cancer who previously had to choose between active surveillance and aggressive treatment with a greater risk for side effects, now have a new option for treatment: focal therapy.

Focal therapy is an overall term that refers to several minimally invasive treatments that target only the parts of the prostate gland where cancer is located. The goal of the treatment is to ablate, or destroy, the tumor and a safety margin within the prostate, while leaving the remainder of the gland intact.

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Focal Therapy Of Prostate Cancer

Posted by Leonard S. Marks, MD | Jul 2019

Leonard S. Marks, presented Focal Therapy of Prostate Cancer during the 24th Annual Southwest Prostate Cancer Symposium on April 13, 2019 in Scottsdale, Arizona.

How to cite: Marks, Leonard S. Does the PROMIS Trial Impact Prostate Cancer Screening? April 13, 2019. Accessed Oct 2021. https://grandroundsinurology.com/focal-therapy-of-prostate-cancer/

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.

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Dealing With Prostate Cancer

Being diagnosed with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently. There are things you can do to help yourself and people who can help.

How Is Cryosurgery For Prostate Cancer Performed

Focal Therapy of Prostate Cancer

Cryosurgery for prostate cancer is done under either general or spinal anesthesia. Before the procedure, an ultrasound probe is placed in the rectum to give the surgeon a visual of the prostate. This allows the doctor to monitor the prostate and nearby organs/tissues during surgery.

Several probes may be placed in the prostate at locations determined before the procedure. These are positioned to avoid the area of the urethra, the tube which passes through the prostate as it carries urine out of the body from the bladder.

In addition, a warming catheter is inserted into the urethra to keep the urethra warm throughout the procedure. Other probes may be placed in and around the prostate gland in order to monitor the temperature and prevent damage to noncancerous tissue.

Cryosurgery takes under two hours and is done in two freezing cycles. In between these cycles, the prostate is allowed to warm, either on its own or with the aid of a warmer gas moving through the probe. After the second thaw, a catheter is inserted into the bladder to help with urination during the recovery period. This tube may be inserted through the urethra, or through a small cut in the lower belly. The catheter will remain in place for several days after surgery.

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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?

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.

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Primary And Salvage Cryotherapy For Prostate Cancer

Cryotherapy is a technique to ablate tissue by local induction of extremely cold temperatures. Recently, the American Urological Association Best Practice Statement recognized cryoablation of the prostate as an established treatment option for men with newly diagnosed or radiorecurrent organ-confined prostate cancer. Emerging data suggest that, in select cases, cryoablation may have a role in focal ablation of prostate. The current state of the art of cryoablation in these applications is reviewed.

Evolution Of Focal Therapy

MDACC 2018: Debate: Focal Therapy for Prostate Cancer

In this presentation, Dr. Ward reviews the evolution of focal therapy during the past 15 years. He discusses the limitations of random systematic prostate biopsies to guide complete eradication of tumors, the three quarters, or hockey stick ablation technique to eliminate index tumors, as well as the impact of multiparametric MRI on focal therapy. Furthermore, he discusses an updated series on the outcomes of focal cryotherapy and the future possibilities of using focal cryotherapy as part of a multimodal strategy.

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Focal Therapy For Prostate Cancer: Complications And Their Treatment

  • 1Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  • 2Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
  • 3Department of Urology, Medical University Innsbruck, Innsbruck, Austria
  • 4Division of Surgery and Interventional Science, University College London, London, United Kingdom
  • 5Department of Urology, University College London Hospital, London, United Kingdom
  • 6Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
  • 7Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
  • 8Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
  • 9Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • 10Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • 11Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
  • 12Department of Urology, Antonius Hospital, Utrecht, Netherlands
  • 13Department of Urology, University Hospital Essen, Essen, Germany
  • 14Division of Nuclear Medicine, IEO European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare , Milan, Italy
  • 15Department of Urology, University Hospital Zürich, Zurich, Switzerland
  • 16Division of Oncology/Unit of Urology, Urological Research Institute, Scientific Institute for Research, Hospitalization and Healthcare Ospedale San Raffaele, Milan, Italy

Who Are Good Candidates For Focal Therapy

When focal therapy for prostate cancer first began to be used in about 2007, it was only as an alternative to active surveillance in very low-risk patients. Since then, the use of focal therapy has expanded to include those with favorable intermediate risk disease . The best candidates have a prostate gland of about 40cc in size or a tumor in the lower half of a larger gland, a single visible tumor on MRI, and the absence of cancer elsewhere in the gland .

In each case, the doctor will consider the patients general health and mental outlook, the size and location of the tumors present, and their chances of spreading more. Use of tests such as MRI, ultrasound, and biopsy can help decide if a patient will benefit more from focal therapy or from traditional treatments.

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What Are The Side Effects Of Cryotherapy

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. Other side effects may include loss of urinary control, injury to the rectum and loss of sexual function. Freezing damages nerves near the prostate and causes impotence in up to four out of five men who have cryosurgery. Erectile dysfunction is more common after cryosurgery than after radical prostatectomy.

The freezing may also affect the bladder and intestines, 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.

The side effects from cryosurgery tend to be worse when treatment is done in men who already had radiation therapy, as opposed to men who have it as the first form of treatment.

Cryotherapy For Prostate Cancer

Focal Therapy for Prostate Cancer | Prostate Cancer Staging Guide

Until now, the treatment of prostatic cancer required a total surgical resection of the gland.A revolutionary minimally invasive technology enables now focal freezing, which destroys only the malignant cells and preserves the prostatic gland as a whole.Benefits: A much less invasive procedure, which does not impair micturition or sexual potencyDrawbacks: The procedure is not suitable for everybody and has approximately 80% success rate

The prostatic gland is an organ in the body that young males are hardly aware of its existence, but older men become increasingly reminded that it is there. Benign hyperplasia of the prostate causes in most older men only difficulties in urination, but a cancerous tumor of the prostate is a malignant disease, which is very common.

The low aggressiveness of prostate cancer together with the excellent treatments that exist today are the reason for the high survival rate of 97% .The surgical treatments of the disease, including Da Vinci robot-assisted laparoscopic procedure, aimed at the complete removal of the gland are considered to be very efficient from the oncological point of view.

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Ucsf Offers Growing Options For Focal Therapy In Prostate Cancer

In its commitment to tailoring prostate cancer treatment to the needs of each patient, UC San Franciscos Department of Urology uses focal therapy as an important option for men with clinically significant cancers that are located in one region of the prostate. Focal therapy delivers a finely targeted energy source to destroy cancer cells, while minimizing damage to surrounding tissue. Now, in addition to using cryotherapy, a focal therapy that freezes tumor tissue, UCSF urologic surgeons have added high-intensity focused ultrasound which uses heat to kill cancer cells as an option for patients whose cancer diagnosis meets certain criteria.

HIFU is administered through a rectal probe targeting the adjacent prostate gland cancer. High-intensity ultrasound beams are focused to converge on the tumor, heating and destroying cancer cells while sparing adjacent tissue. This treatment allows urologists to observe the ablation in progress, so they can visualize tumor destruction in real time, says Katsuto Shinohara, MD, who along with Hao Nguyen, MD, PhD, leads UCSFs focal-therapy program.

Patient-Selection Criteria

What Is The Outlook For Patients Who Receive Focal Therapy

While the use of focal therapy for localized prostate cancer appears to be a promising development in a number of ways, it is still considered investigational and not yet part of standard therapy. There are a number of reasons for this, as follows:

  • The criteria for selecting ideal candidates havent been fully agreed on. This is an important question because mistakenly using focal therapy in place of a more traditional treatment could allow a cancer to go under-treated.
  • The criteria for defining an index lesion still need to be agreed on.
  • The idea that the index lesion determines how the cancer will develop hasnt yet been proven.
  • The factors that define treatment success or failure, and the triggers for re-treatment still need to be determined.
  • The long-term effectiveness of focal therapy is unknown.
  • It isnt clear that all side effects are eliminated by using focal therapy.
  • Focal therapy doesnt allow for firsthand pathologic and biologic study of cancerous tissue, as can be done when using surgical treatment.
  • Focal therapy sometimes leaves behind untreated cancer, which could possibly raise the risk of more serious problems in the future.
  • The overall cost to the healthcare system may be greater for focal therapy than for standard treatments.

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