Although the concept of destroying prostate cancer cells through freezing has been around for quite some time, many prostate cancer patients do not understand what cryotherapy is and how it can used treat their prostate cancer. Cryotherapy, also referred to as cryosurgery or cryoablation, is an old concept made new with its modern techniques of freezing prostate tissue. Similar to how tissue is destroyed with frostbite, cryotherapy uses controlled freezing to destroy abnormal tissues. This application of freezing temperatures to destroy cancer was first documented in the mid-1800s, but difficulty in controlling how much tissue was frozen made cryrotherapy side effects intolerable. However, recent advancements in cryotherapy techniques now allow for a more precise application of cryotherapy. For prostate cancer patients, this means relative simplicity, reduced cost, quickness and ease in their treatment for prostate cancer. Cryotherapy is still considered experimental and new, so its long-term results are still being determined. Some experts believe that cryotherapy treatment results are comparable to, and in some instances better than, other forms of prostate cancer therapy, such as radiation.
Although regarded as a promising form treatment for prostate cancer, there is still concern that the cryotherapy procedure can leave some cancer cells untreated, because they were outside the prostate and may allow others to escape from being frozen.
Advantages of Cryotherapy for Prostate Cancer
Cryotherapy may be appropriate for men with a range of stages and grades of prostate cancer. Other advantages to cryotherapy include:
- Cryotherapy for prostate cancer is not as invasive as radical prostatectomy. This allows for less pain and bleeding, and avoids potential complications of a more invasive surgical procedure.
- Because of the precise method now used to destroy prostate cancer, cryotherapy is better able to preserve healthy tissue.
- Cryotherapy for prostate cancer may be used if necessary after standard treatments such as brachytherapy and external beam radiation, and can be conducted repeatedly if necessary.
Good Candidates for Cryotherapy for Prostate Cancer
Men with PSA levels of 5ng/ml are thought to be the best candidates for cryotherapy. However, in reality, most men with prostate cancer are likely candidates for cryotherapy, from prostate cancer patients with low-grade disease to those with more advanced cancers.
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Unlikely Candidates |
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As with all treatment options, the patient and his doctor need to consider the overall health of the patient before making any decisions.
Cryotherapy for Prostate Cancer that Recurs
Some men opt for cryotherapy when prostate cancer recurs after initial treatment with radiation or prostatectomy. Because radiation destroys anatomical landmarks and causes scar tissue, surgery cannot be performed on most men who have already had radiation treatment, thus cryotherapy is one of the few options available.
Studies suggest that while undergoing a cryotherapy procedure after recurrence can be very effective, it appears to be most effective as soon as PSA levels starts to rise but when the cancer has not metastasized beyond the prostate. However, cryotherapy may not be as effective against prostate cancer that has recurred after radiation treatment and hormone therapy. Research is still ongoing as to the efficacy and long-term outcomes of cryotherapy after prostate cancer recurrence.
What is Cryotherapy Procedure?
Cryotherapy procedure is performed in a hospital, under local (spinal or epidural) or general anesthesia, and the patient usually remains overnight. Long needles called cryoprobes are inserted into the prostate through the perineum, which is the area between the anus and scrotum. A freezing substance, typically argon gas (liquid nitrogen was used in the past), is inserted through the needles and freezes the prostate. Cryotherapy is now more accurate with fewer severe side effects, because an ultrasound probe is inserted into the rectum so that the urologist can precisely place the cryoprobes and ensure that normal tissue outside of the prostate is not frozen. Since the urethra runs directly through the prostate, a warming device, such as a catheter, carrying warm, circulating water, is inserted through it so that the urethra will not also be frozen. After cryotherapy procedure, a urinary catheter is left in place for approximately 2 weeks, until the patient can urinate on his own.
Cryotherapy Side Effects
Although it is a minimally invasive treatment for prostate cancer, cryotherapy side effects can occur from damage to the surrounding tissue during the cryotherapy procedure. Most side effects disappear soon after cryotherapy treatment. However, doctors will want to monitor them to make sure there is proper intervention, should cryotherapy side effects become more serious. The following are side effects men may experience after prostate cancer cryotherapy:
- Hematuria (blood in urine)
- Impotence
- Incontinence
- Irritation during Urination
- Scrotal Edema
- Swelling in the Genital Area
- Urethral sloughing and Urinary Obstruction
- Urethro-Rectal Fistula
Long Term Outcomes of Cryotherapy for Prostate Cancer
Since the technology of cryotherapy for prostate cancer is still evolving, its long-term results are yet to be fully determined. There are two particular concerns with cryotherapy: some prostate cancer cells (those which are immediately adjacent to the urethra) can be inadvertently warmed during the cryotherapy procedure and end up surviving, and if there are cancer cells that are outside of the prostate, cryotherapy will not affect them at all.
Although some outcome information on the use of modern cryotherapy treatment techniques are now emerging, the long-term results of cryotherapy for prostate cancer varies widely. One study, where rising PSA was measured, suggested that the chance for recurrence after two years was 40% for low risk, 55% for intermediate risk, and 64% for high-risk cancers. Another study indicated that 7 years after the procedure, there were recurrence rates reported at 39% in men with low-, intermediate-, and high-risk cancers. In yet another study, 8 years after undergoing cryotherapy, prostate cancer patients with low-grade cancer had a 92% chance of showing no evidence of disease, while those with slightly more aggressive cancer have an 80% chance of no evidence of disease. Even more impressive were those who had the most aggressive prostate cancers. These men showed a 65% chance of no evidence of disease after the 8 years. More promising are the biopsies taken after cryotherapy for prostate cancer. 85% to 95% of these biopsies were negative for malignancy, regardless of the original nature of the cancer.
