Your prostate cancer cryosurgery procedure is usually carried out in a hospital, where you remain overnight. It is performed in an operating room under general or spinal anesthesia, with techniques similar to those used in implanting seeds in radiation seed therapy. The procedure can range from 1 to 2 hours. Men who undergo cryosurgery for their prostate cancer can usually go home the same day.
Typically, before cryosurgery on the prostate cancer begins, a suprapubic catheter is inserted through a hole in the skin of your lower abdomen. The catheter is used to drain your urine from your bladder, since cryosurgery makes the prostate to swell up after freezing, similar to frostbitten tissue, and may obstruct the urethra and prevent you from normal urination. Also, since the urethra runs directly through your prostate, a urethral warming device is inserted through your penis and into your bladder to help lessen cryosurgery side effects and any complications associated with the freezing of the urethra.
Devices, called thermocouples, are inserted through the perineum which is the area between your scrotum and anus. They measure the temperature at critical areas within your prostate to make sure the cancerous cells have reached a temperature of -40 degrees Celsius and to help prevent the freezing of critical normal tissue, such as the rectal wall, during your cryosurgery procedure.
Guided into place by transrectal ultrasound, 6 to 8 long needles, or cryoprobes, are inserted into your prostate through your perineum. The freezing substance, typically argon gas, of the cryosurgery treatment is then inserted through the needles and freezes the prostate into what is referred to as an ice ball.
After the second freeze of cryosurgery treatment, your prostate is allowed to thaw completely. The probes and thermocouples are removed. Absorbable suture, which dissolves over time, or pressure is applied to the small incisions on the perineum, where the devices were inserted, to close and prevent bleeding. The urethral warmer sometimes remains in place while you are in the recovery room.
Following the procedure, a urinary catheter is left in place for approximately 2 weeks, during which time most men do not go back to work. The catheter is removed when a man is able to urinate and empty his bladder, which typically occurs about 10 to 14 days after the cryosurgery for prostate cancer.
Prostate Cancer Cryosurgery Side Effects
After cryosurgery, prostate cancer patients may experience fatigue for about a week. Some also will have discharge, swelling of the scrotum, pain or burning during urination, and increased urination frequency or urgency. As with all surgical procedures, there is a possibility that the following complications may develop after your cryosurgery procedure:
- Erectile Dysfunction – prostate cancer cryosurgery is associated with higher rates of impotence than most other localized prostate cancer treatment options. During the cryosurgery procedure, it is virtually impossible to freeze the prostate without freezing the adjacent arteries, nerves, and veins that run to the penis. Over 80% of men who undergo cryosurgery for prostate cancer experience erectile dysfunction. This number drops to about 50% in men with low grade tumors. Unlike their counterparts with a larger volume of prostate cancer, these cryosurgery patients are better able to preserve erectile function.
- Swelling of the genitalia – During cryosurgery for prostate cancer, the insertion of the needles, or cryoprobes, through perineum (the skin and muscles between the scrotum and anus) often causes irritation and inflammation. Many doctors will recommend using ice packs on the affected area or beginning a regimen of over-the-counter anti-inflammatory drug.
- Urinary retention – The inability to urinate following cryosurgery for prostate cancer is the next common side effect, occurring in about 65% of men who undergo the treatment. This is caused when the prostate swells after freezing and blocks the urinary channel. To bypass obstruction, doctors typically place a tube in the bladder during cryosurgery. Prostate cancer patients are able to urinate normally within 1 to 2 weeks, and the tube is removed in a painless procedure.
- Prostatic slough – If the section of the urethra that runs through the prostate is damaged by the freezing process of cryosurgery, a complication called prostatic slough occurs. The risk of this side effect is rare (less than 4%) now with the use of a warming catheter during the cryosurgery procedure. When the sloughing is severe, it can cause urinary obstruction and require medical intervention. When this happens, it treated with prolonged catheter drainage, more commonly called a transurethral resection of the prostate (TURP).
- Permanent urinary leakage or incontinence -The complications of cryosurgery for prostate cancer are now much fewer than in the past. Permanent urinary leakage or incontinence occurs less than 1% of the time with cryosurgery treatment.
- Urethro-rectal fistula – During cryosurgery treatment, the rectum wall (the tissue next to the rectum) can be frozen accidentally, and a fistula, a hole, may be created between the rectum and the urethra. Doctors with more experience in cryosurgery for prostate cancer may produce fewer fistulas than those who have performed fewer cryosurgery procedures. These holes usually will heal. However, when the complication is very serious and life-threatening, more aggressive surgical management will be required.
- Irritation during urination – After undergoing cryosurgery for prostate cancer, it is common to experience itching or burning while urinating, as well as the urgency to urinate. Symptoms usually subside in a few days after the cryosurgery procedure. If symptoms worsen rather than leave, you should notify your doctor so that he can do evaluate the symptoms further.
- Hematuria – You may experience blood in your urine, or hematuria after undergoing prostate cancer cryosurgery. Two types of hematuria, gross and microscopic, may occur. Gross hematuria is visible to the naked eye. You should notify your doctor if the bleeding does not go away after a few days.
- Scrotal edema – Although rare, one of the more severe of cryosurgery side effects is scrotal edema. It occurs when fluid collects in the scrotum. Your doctor will need to do a proper evaluation to determine the proper course of treatment.
- Other potential side effects of cryosurgery – Following cryosurgery, prostate cancer patients may also experience discomfort in the rectal area, bruising, penile numbness, and incomplete voiding of the bladder. Most of these problems will disappear soon after the procedure.
The Future of Cryosurgery for Prostate Cancer
Advances in cryotherapy treatment techniques and equipment such as new computerized methods of freezing the prostate are in development, and are likely to become useful in planning and performing cryosurgery. For prostate cancer patients with low-risk disease, a more standardized form of prostate cancer cryosurgery called local ablation of the prostate could be used, thus sparing normal prostate tissue. It could also be used with cryotherapy to possibly improve the survival of men with advanced disease; early outcomes of cryosurgery appear positive, but more testing is needed to compare outcomes with other prostate cancer therapies.
