(also known as cryotherapy, cryoablation, or cryosurgical
ablation) is a procedure in which the prostate gland is
frozen under controlled conditions in order to kill cancer
cells. Used for many years in the treatment of skin cancer,
cryosurgery is currently considered an experimental therapy
for prostate cancer because there are no long-term results
to document the technique's effectiveness.
works best on prostates 40 grams or less in size as measured
by ultrasound. Three to six months prior to the procedure,
the patient is placed on hormone therapy to block production
of male hormones, which cause prostate cancer to grow. Hormone
therapy shrinks the prostate and cancer prior to cryosurgery
and improves the chances of freezing the entire prostate.
procedure is performed while the patient is under either general
or local anesthesia. Special metal probes are inserted through
the perineum (the area between the scrotum and anus)
and directly into preselected locations in the prostate gland.
Liquid nitrogen is then circulated through the probes to freeze
the entire gland. The goal is to create an "ice ball" large
enough and cold enough to kill the cancer.
ultrasound probe placed in the rectum guides the placement
of the probes, monitors the formation of the ice ball and
ensures that the rectal wall is not frozen. A warming catheter
filled with a saltwater solution is placed in urethra to keep
it warm during procedure. During the procedure, a Foley catheter
is inserted to drain urine; it is left in place for two to
three weeks. Typical hospital stays are one to two days.
Appropriate candidates for cryosurgery
whose cancer is localized to the prostate gland.
who haven't had previous prostate surgery, including transurethral resection of the prostate (TURP).
whose prostates are 40 grams or less in size as measured
with high Gleason scores. Cryosurgery
is used for local control of the tumor and as an adjunct
to hormone therapy.
Those who should consider other treatments
whose cancer has spread to the lymph nodes or other parts
of the body.
Side effects and complications of cryosurgery
most common side effects are bladder or urethral irritation,
causing such symptoms as frequent urination with little
warning and burning, blood, or pain with urination. Irritation
to the rectal wall may also occur. Penile or scrotal swelling
occurs in about 50 percent of men; this is usually temporary.
to 80 percent of men have some level of erectile
dysfunction after cryosurgery. The level depends
on how aggressively the prostate tissues have been frozen.
of the main risks of cryosurgery is the potential formation
of a fistula — an abnormal connection between
the urethra and rectum — and the possibility of
not completely destroying the cancer cells.
a 1997 study of the effects of cryosurgery, the most common
serious complication was bladder outlet obstruction
(a narrowing of the urethra at the bladder neck, obstructing
the flow of urine). Transurethral resection of the prostate
(TURP) was required to fix the problem in 23 percent of
complications include urethral scars causing such difficulty
in urinating that a catheter is required.
Advantages of cryosurgery
and quickness of the procedure
hospital stay and recuperation
serious problems with incontinence
from early side effects.
Disadvantages of cryosurgery
rate of complications
of long-term studies of the effectiveness of cryosurgery
are not yet available
procedure may not be covered by your insurance. Several years ago,
however, the Health
Care Financing Administration approved reimbursement
of cryosurgery for primary treatment of prostate cancer.
concerns that some cancer cells may escape freezing and
concerns that other cells may be outside the prostate
and will not be treated.
1 Aboseif S, Shinohara K,
Borirakchanyavat S, Deirmenjian J, Carroll PR. The effect
of cryosurgical ablation of the prostate on erectile function.
Br J Urol 80(6):918-22.
Prostate Cancer pages of this website are part of the Comprehensive
Prostate Cancer Awareness Program (CPCAP), a major regional
effort to reduce the rates of death and illness caused by
prostate cancer in southwestern Pennsylvania. Funding for
CPCAP is provided by a grant from the Commonwealth of Pennsylvania.
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