Cryotherapy for prostate cancer

Cryotherapy is a way of killing cancer cells by freezing them. It is also called cryoablation or cryotherapy. Doctors can use cryotherapy as a treatment for people with early stage prostate cancers that have not spread beyond the prostate gland. Although this treatment is safe for men with early stage prostate cancer we do not yet know whether it is as good as other treatments such as surgery to remove the prostate gland or radiotherapy. We also don’t know how much effect it has on men’s quality of life, compared to other treatments.

Doctors can also use cryotherapy for men whose prostate cancer has come back in the area of the prostate gland after initial treatment (recurrent prostate cancer).

Patients need to be assessed for this treatment by a specialist urological cancer multidisciplinary team. It is mainly available in specialist hospitals. Your doctor will explain all the possible risks and benefits to you beforehand.

You can have this treatment under local anaesthetic or with a general anaesthetic. It usually takes between 1 to 2 hours. You usually have it as a day patient but may need to have an overnight stay.

Before the treatment you may have an enema to clear out the lower bowel. In the treatment room the doctor puts a tube called a warming catheter into the tube in the body that takes urine from the bladder to the tip of the penis (the urethra). This protects the urethra from damage during the treatment.

The surgeon then puts special cryotherapy needles through the skin of the perineum (the area between the scrotum and the anus). They use an ultrasound scan or X-rays to make sure the needles are in the right place. A machine then circulates argon gas through the needles to freeze the tissue.

The surgeon uses temperature needles to monitor the temperature of other structures in the area such as the bowel muscle (anal sphincter) and the back passage (rectum). They make sure that these do not get damaged by the cold.

The surgeon removes the cryotherapy needles and the temperature monitoring needles. Your nurse will then take you to a room or a ward to rest for a few hours.

You have a tube (catheter) to drain urine from your bladder for 1 or 2 weeks after the treatment. You can usually get up and about a few hours after the procedure. But it is best not to do any strenuous exercise or to stand for long periods while you have the catheter in place.

You will have regular blood tests to check your levels of a protein called prostate specific antigen (PSA) to see how well the treatment has worked.

The treatment area can be painful after the local anaesthetic wears off. There is some bruising and you will need to take painkillers for a few days after your treatment.

You may have constipation for a few days and may need to take laxatives and drink plenty of fluids.

You may have some blood in the urine for several weeks after the treatment. If the bleeding lasts for more than a few weeks or is getting worse let your doctor know.

There can be a higher risk of erection problems (impotence) after cryotherapy than with some other treatments for early prostate cancer. Between half of men and all men (50% to 100%) will have erection problems after cryotherapy. The nerves that control erections lie just behind the prostate gland and are included in the freezing process. Your surgeon will discuss this with you. There is information about managing erection problems in the sex and cancer section.

Up to 18 men out of 100 (18%) have some long term loss of control of urine (urinary incontinence) particularly during coughing and sneezing. Your nurse or doctor will give you pelvic floor exercises to do to reduce the chance of incontinence.

A small number of men may have blockage of the urethra and have problems passing urine after cryotherapy. They need an operation called a transurethral resection of the prostate (TURP) to help them pass urine again.

Very rarely, damage can occur to the back passage (fistula) that may need surgery to repair.

A small number of men have infection after cryotherapy and need to take antibiotics.