What is cryotherapy for prostate cancer?

The prostate gland is found only in males. It sits below the bladder and wraps around the urethra, the tube that carries urine out of the body. The prostate helps make semen.

Cryotherapy involves freezing the cancer cells and cutting off their blood supply. Tiny needles are placed right into the tumor. Argon gases are passed through the needles and exchanged with helium gases. This causes a freezing and warming cycle. The frozen, dead tissue then thaws and is naturally absorbed by the body.

Cryotherapy can be used to treat a variety of problems. When used to treat prostate cancer, a warming catheter is put into the urethra to keep it from freezing. The needles are guided into the prostate tumors using ultrasound imagery to guide them.

Why might I need cryotherapy for prostate cancer?

Cryotherapy may be a good treatment option for prostate cancer treatment in the following situations:

• Men with cancer in the prostate gland that hasn’t spread to other parts of the body

• Men who aren’t well enough to get radiation or procedure

• When the goal isn’t to cure, it may be useful for men who have cancer that has spread beyond the prostate gland and need treatment for symptoms

• Sometimes it’s used for men who have had unsuccessful results with radiation therapy

Some experts believe cryotherapy can be helpful when the prostate cancer cells aren’t as sensitive to radiation.

Cryotherapy may not be recommended for men who have a very large prostate gland.

Cryotherapy is less invasive than standard procedure. It involves needles that are put in through the skin under the scrotum, called the perineum. There is less blood loss, a shorter hospital stay, faster recovery, and less pain. It can be repeated, if needed.

There may be other reasons for your healthcare provider to recommend cryotherapy.

What are the risks of cryotherapy for prostate cancer?

As with any procedure, complications can occur. The risk of permanent erectile dysfunction (ED) is very high with cryotherapy. This makes it a better choice for men who aren’t as concerned about ED after treatment. Some other possible complications may include:

• Bleeding and/or blood in the urine

• Soreness or swelling in the region where the needles are put into the body (between the scrotum and the anus)

• Infection

• Swelling around the penis or scrotum

• Freezing may affect the bladder and intestines, which can lead to pain and burning sensations

• Urge to empty the bladder and bowels more often (usually goes away in several weeks)

• Urinary incontinence is rare, but this may be more common if the man has had radiation therapy in the past

• An abnormal connection (fistula) between the rectum and bladder or urethra is a rare complication

There may be other risks depending on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for cryotherapy for prostate cancer?

Here are some things you can expect before cryotherapy for prostate cancer:

• Your healthcare provider will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything isn’t clear.

• Your doctor will review your medical history and do a physical exam to be sure you are in good health before you have the procedure. You may also need blood tests and other tests to make sure the cancer is confined to the prostate.

• You will be asked to fast (not eat or drink anything) for 8 hours before the procedure, generally after midnight.

• Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, iodine, tape, and anesthesia.

• Make sure your healthcare provider has a list of all medicines and all herbs, vitamins, and supplements that you’re taking. This includes prescribed and over-the-counter medicines.

• Tell your healthcare provider if you have a history of bleeding problems or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or any other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

• If you smoke, stop as soon as possible. This improves your recovery and your overall health status.

• You will be asked to take a laxative and/or enema to empty your colon the night before procedure. Make sure you understand these directions and have the supplies you need.

• You may be given a sedative before the procedure to help you relax.

Based on your condition, your healthcare provider may request other specific preparation.

What happens during cryotherapy for prostate cancer?

Cryotherapy may require a one-day stay in the hospital. It may also be done as an outpatient procedure. Procedures may vary depending on your condition and your healthcare provider’s practices.

Generally, cryotherapy follows this process:

1. You will be asked to remove any jewelry or other objects that might get in the way during procedure.

2. You will be asked to remove your clothing and will be given a gown to wear.

3. You will be asked to empty your bladder.

4. An IV line will be put in your arm or hand.

5. The doctor may choose regional anesthesia or general anesthesia. You will also get medicine to help you relax and pain medicines.

6. If you get general anesthesia, a breathing tube may be put through your throat into your lungs and you will be connected to a ventilator. This will breathe for you during the procedure.

7. The anesthesiologist will watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

8. You will be placed on your back on the operating table with your legs up in stirrups.

9. The healthcare provider will put a soft, flexible catheter through your penis and into your bladder to drain urine. The catheter will be filled with warm salt (saline) solution. It will help keep urine draining even if the prostate gland swells after the treatment. The catheter will also be used to keep the warm saline moving through the urethra to protect it from the cold temperatures used during the procedure.

10. A transrectal ultrasound (TRUS) probe will be put into your rectum so that the prostate and nearby tissues can be seen on a computer screen.

11. The healthcare provider will insert the cryoprobes (needles) into the preselected areas between the scrotum and anus. Gas will be put into the needles to freeze the nearby prostate tissue. The frozen area will stay frozen for only a few minutes then will be thawed by putting helium through the needles. This cycle may be repeated.

12. The surgeon will use the ultrasound images to watch the freezing process to be sure only the cancer is being treated.

13. The needles and TRUS probe will be removed and the urinary catheter will be left in your bladder.

14. If used, the breathing tube will be taken out and you will breathe on your own.

15. A sterile bandage/dressing will be applied.

What happens after cryotherapy for prostate cancer?

In the hospital

After the procedure, you may be taken to a recovery room before being taken to a hospital room. You will be connected to monitors that will display your heart rate, blood pressure, breathing rate, and your oxygen level.

Once you are stable and awake, you will be taken to your hospital room. You may also start to drink liquids.

You may get pain medicine as needed, either by a nurse, or by giving it yourself through a device connected to your IV line.

You can gradually return to solid foods as you are able to handle them.

You may start to take antibiotics after the procedure is done and continue them for a few days after it. This is to help prevent infection.

Your recovery will continue to progress. You will probably have some bruising and swelling in the area where the probes were inserted. You will be encouraged to get out of bed and walk the same day. You may be able to go home the same or the next day.

You may notice some blood in your urine for a day or two after the procedure. Swelling in the penis or scrotum is common. You may also have pain in your belly (abdomen) and burning sensations which may make you feel the urge to go to the bathroom more often.

The catheter will stay in for 1 to 3 weeks to help urine drain while your prostate gland heals. You will be given instructions on how to care for the catheter at home.

Arrangements will be made for a follow-up visit with your healthcare provider.

Your healthcare provider may give you other instructions after the procedure, depending on your situation.

At home

Once you are home, it will be important to keep the surgical area clean and dry. Your healthcare provider will give you specific bathing instructions.

The needle insertion sites may be tender or sore for several days after cryotherapy. Take a pain reliever for soreness as recommended by your healthcare provider.

You shouldn’t drive until your healthcare provider tells you to. Other activity restrictions may also apply.

Be sure to keep any follow-up appointments so your healthcare provider can make sure you're recovering well. The catheter will be taken out at one of these follow-up appointments.

Call your healthcare provider if you have any of the following:

• Changes in your urine output, color, or odor

• Inability to urinate once catheter is removed

• Increase in pain around the needle insertion sites

• Fever and/or chills

• Redness, swelling, bleeding, or other drainage from the needle insertion sites

Your healthcare provider may give you other instructions after the procedure, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure