Cryotherapy (or cryoablation) is the controlled freezing of the prostate gland in order to destroy cancerous cells. It works by rapidly freezing and thawing cells. This causes damage to the cell and makes it difficult for the cell to survive.
Who are the Most Suitable Candidates for Cryotherapy?
Cryotherapy is suitable for many prostate cancer patients who are seeking minimally invasive treatment instead of surgery or those who prefer not to have radiotherapy. The prostate cancer needs to be confined to the prostate. Your urologist will have a list of criteria for choosing suitable patients. Cryotherapy may also be used if you have developed a recurrence following radiotherapy.
In general men with smaller prostates are better candidates but those with larger prostates can undergo hormone therapy to decrease the size of the prostate prior to cryotherapy.
How is Cryotherapy Performed?
Cryotherapy may be performed under general or spinal anaesthetic. An ultrasound probe is guided into the rectum and the prostate is imaged. Under continuous ultrasound monitoring, the cryotherapy needles are placed at predetermined sites within the prostate. The urologist is able to change the placement of needles or add and remove needles if necessary, to ensure complete treatment.
A catheter, through which warm water is circulated, is inserted in the penis to protect the urethra against damage from the cold. This minimises the risk of urethral damage and complications. The urethral warming catheter remains active for about 20 minutes after complete thawing to prevent freezing of the urethra.
The freezing starts at the front part of the prostate by activating the front needles, followed by the middle and finally the back needles. This sequence allows visualisation of the freezing process through the transrectal ultrasound. Two freezing cycles are usually done, with the prostate being thawed between cycles.
Following the treatment cycles the urethra and bladder are examined with a flexible cystoscope for evidence of injury. A urethral catheter is left in place following the procedure to facilitate drainage of urine.
What Happens after Cryotherapy?
You will stay in hospital for 1 – 2 nights. You may eat and drink as soon as you are awake and will be encouraged to walk.
It is up to your urologist when the urethral catheter is removed. You will be discharged with a suprapubic catheter and your nurse will teach you how to look after it at home. The suprapubic catheter can be removed after 7 days.
Oral antibiotics may be prescribed for 10 – 14 days.
Some of the symptoms you may experience following cryotherapy include:
- Generalised fatigue (for 7 – 10 days)
- Urethral discharge
- Scrotal swelling
- Pain or burning sensation on passing urine
- Increased urinary frequency or urgency
- A PSA test is usually done at 3 months and then every 6 months while your consultant considers it necessary.
What are the Risks?
There is a high incidence of erectile dysfunction (impotence) following cryotherapy, although a small percentage of men will regain potency spontaneously within 2 years.
Other complications, although uncommon, include:
- Urinary incontinence (approximately 1% rate of permanent incontinence)
- Tissue sloughing (typically 3 – 8 weeks post treatment)
- Pelvic and rectal pain
- Penile numbness (usually temporary, resolving spontaneously in 2 – 3 months)
- Urethral stricture
- Urinary retention requiring transurethral resection of the prostate
- Inflammation of the testicle
- Recto-urethral fistula is the most critical risk with a reported incidence of 0 – 3%. This is a channel, which is created between the prostate or bladder and the rectum and may cause diarrhoea due to urine in the rectum and possibly infection due to bacteria in the bladder. Conservative treatment is usually initiated following diagnosis