Cryotherapy, also known as Cryosurgery, Cryo, and Cryoablation, is a minimally invasive treatment (no incisions) that uses extremely cold temperatures to kill cancer tumors. Cryotherapy is widely used around the world and has over fifteen years’ reported clinical experience to support its safety and effectiveness. The treatment is also recognized by both the American Urological Association (AUA) and the European Association of Urology (EAU) as a treatment for prostate cancer.

To treat a patient with cryoablation, doctors generate ice utilizing specially designed thin needles which encompass the targeted area with iceballs. This ice is very precisely shaped and positioned to destroy all of the cancerous tissue. The process is carefully controlled by the doctor who uses ultrasound imaging and temperature monitors to help ensure that the healthy tissue surrounding the prostate is not affected by the cold temperatures.

a. Primary Prostate Cryoablation

  1. The patient is placed in the dorsal lithotomy position.
  2. An ultrasound probe is inserted into the rectum to create an image of the prostate which allows the doctor to view the placement of cryoablation needles and the entire freezing process during the cryoablation treatment.
  3. The number of 1.5 mm cryoablation needles and their configuration depends upon the type of cryoablation needle used, and the shape and size of the prostate.
  4. BTG’s 1.5 mm Multi-Point Thermal Sensors (MTS) are inserted within the prostate and adjacent tissue to monitor the lethal temperature throughout the target tissue, while avoiding damage to the rectal wall and the urethra.
  5. A warming catheter is used to protect the urethra from freezing.
  6. Under real-time ultrasound imaging and temperature monitoring, two freeze/thaw cycles are employed, ensuring a minimum temperature of -40° Celsius throughout the prostate tissue.

b. Salvage Prostate Cryoablation

The process of salvage prostate cryoablation treatment is similar to primary prostate cryoablation treatment, with only minor differences. Most men, but not all, who undergo salvage prostate cryoablation treatment have had some type of previous radiation treatment for their prostate cancer.

Salvage prostate cryoablation has been proven to be just as effective as salvage prostatectomy, also known as surgery, with notable reductions in rectal injury and incontinence.

c. Focal Prostate Cryoablation

Focal prostate cryoablation follows similar principles as standard prostate cryoablation. Focal prostate cryoablation only freezes a portion of the prostate as opposed to the entire gland. Focusing on the specific areas where the physician believes the cancer resides allows doctors to preserve other regions of the prostate – in particular the nerves associated with potency (the ability to obtain and maintain an erection suitable for sexual intercourse) and the urinary sphincter which controls continence.

Focal prostate cryoablation is a relatively new technique but initial evidence supports that most men receiving the treatment remain potent and only a very small percentage become incontinent (lose the ability to control their urine flow). It is important that patients understand that focal prostate cryoablation may only be a temporary solution. Because focal prostate cryoablation focuses on a specific area of the prostate, at least half of the gland will go untreated. This may mean that small, developing tumors are not destroyed.

All patients undergoing focal prostate cryoablation should have very regular follow-up care to carefully monitor any changes. Focal prostate cryoablation does not exclude any treatment options for the future – including a repeat focal prostate cryoablation or primary prostate cryoablation.

d. Side Effects

Dr. Waterhouse discusses what patients need to know about primary cryotherapy before making their decisions.

Some patients may experience the following side effects after cryoablation treatments:

  • Swelling of the penis or scrotum. The gland swells, preventing urine from leaving the bladder. As a result, a catheter is often required for a couple of weeks until swelling subsides. The perineum (the area between the anus and scrotum) may also swell or feel sore.
  • Freezing may affect the bladder and intestines, which can lead to pain, burning sensations, and the need to empty the bladder often. Most men recover normal bladder function in a matter of weeks.
  • Any damage to the urethra from the cryoablation freezing may cause obstruction or sloughing of the urethra. This side effect has been greatly decreased with the use of a warming catheter during the prostate cancer treatment process to protect the urethra from freezing.
  • In very rare cases, a fistula, an unnatural join between two hollow organs, occurs between the rectum and urethra. The fistula occurs as a result of tissue damage from freezing. This allows urine to leak into the rectum and may require surgery to repair. This rare side effect affects about one percent of cryosurgery patients.
  • One potential side effect of all prostate cancer treatments, including cryosurgery, is incontinence; the inability to control urine flow. If incontinence occurs, there are varying types of urinary incontinence and differing degrees of severity.
  • Another side effect of cryoablation is impotence. Impotence is the inability to maintain an erection. Sexual impotence is one of the most common side effects of cryoablation. The freezing process during cryoablation may affect nerve bundles near the prostate that are associated with an erection.

Dr. Waterhouse explains post salvage cryotherapy procedure.

e. Follow Up

Follow-up care after any prostate cancer treatment remains extremely important. A doctor may choose to regularly examine a prostate cancer patient to be sure the cancer has not returned or progressed. You should consult with your doctor on your follow-up schedule post-cryoablation.

How quickly were you able to resume your normal activities after primary prostate cryotherapy?