Cryotherapy
A minimally invasive and relatively new procedure used to treat localized prostate cancer that uses very low temperatures to “freeze” cancer cells. The procedure is also known as cryosurgery or cryoablation.
In this technique, the surgeon (with the help of a transrectal ultrasound) places five to eight probes through the patient’s skin into the prostate gland. Once the probes are positioned correctly, the physician administers liquid nitrogen through the probes to freeze the prostate. The liquid nitrogen forms a ball of ice in the prostate; once it melts, it ruptures the cancer cells, killing them. Typically, physicians administer two freezing-and-melting cycles during one procedure to be sure all the cancer is eliminated.
The doctor normally inserts a warming catheter into the urethra (which travels through the prostate gland) to prevent the urethra from freezing.
Usually after this procedure, the cancer is eliminated and the prostate-specific antigen (PSA) level returns to normal. The procedure does not involve incisions; therefore, recovery is quick.
On the other hand, if the procedure is not performed carefully by a very experienced physician, healthy tissue surrounding the prostate may be damaged, producing unwanted side effects. Moreover, if the nerve bundles that control erection are frozen during this procedure, impotence may result. Although some doctors can freeze the prostate and spare the nerve bundles in a process known as nerve-sparing cryosurgery, that more difficult procedure is not always successful.
Although the method has been used by some physicians since the 1970s, it was not widely used until 20 years later, as new types of probes and more advanced ultrasound technology were developed. However, many doctors remain unconvinced of the benefits of this type of treatment, and very few physicians perform this technique.
Cryosurgery may be a good choice for someone who does not want radiation or surgery but wants some form of therapy for cancer. This method is also sometimes used as a follow-up treatment for a patient who has not responded to the initial treatment. It is more accepted as a form of salvage therapy used after men have failed initial radiation therapy. When used after radiation, the technique can produce uncomfortable side effects such as burning, incontinence, and rectal injury, but these risks are lower than those with surgery after previous prostate radiation.
Cryosurgery is covered by most insurance companies and by Medicare.