Cryotherapy for Prostate Cancer
What is cryotherapy for prostate cancer?
Cryotherapy uses very cold temperatures to “freeze” prostate tissue and kill cancer cells. It may also be called cryosurgery. Cryotherapy can be done to the entire prostate gland or to one or more areas (called focal cryotherapy). The cold temperatures can also damage healthy tissue in the area. Your provider takes steps to protect the healthy tissue in the area and lessen the risk of side effects.
Who can have cryotherapy to treat their prostate cancer?
Cryotherapy can be used to treat prostate cancer that is limited to the prostate gland and has not spread to other areas of the body (non-metastatic). It is most often used for early-stage or low-risk cancers. It may be a good option for men who cannot have surgery or radiation therapy or if the cancer has come back after radiation treatment.
How is cryotherapy given?
Cryotherapy is done in the hospital. You are given anesthesia (general or local anesthesia) so you will not feel the procedure being done.
An ultrasound probe is placed in the rectum and used to guide what areas are treated and to monitor the procedure. A catheter is placed in the urethra (the tube that drains urine from the bladder). This catheter is filled with warm water to protect the urethra from freezing during the procedure. Several thin needles are placed into the prostate gland, through the perineum (the skin between the scrotum and anus). The ultrasound is used to guide where these needles are placed. A very cold gas (Argon gas) is put into the needles and this is what freezes the nearby tissue.
After the procedure, you will have a catheter in place to drain your urine for a few weeks. You may go home the same day or stay in the hospital overnight. You will be given instructions on caring for the procedure area, managing soreness or pain, activity restrictions, and when to call your healthcare provider.
What are the possible side effects of cryotherapy for prostate cancer?
While freezing prostate tissue, healthy tissue in the area can be damaged by the temperatures. This type of damage can cause:
- Nerve damage that leads to erectile dysfunction.
- In rare cases, a fistula (hole or connection) from the rectum to the bladder or urethra.
- Urinary incontinence, which is most common when cryotherapy is used after radiation.
Other potential risks related to the procedure can include: infection, bleeding, pain, frequent or difficult urination, blood in the urine, needing to move bowels frequently or swelling in the scrotum or penis.
What are the “pros” of cryotherapy?
Cryotherapy is less invasive than other treatments. The treatment time is shorter, requires less time in the hospital, and results in less bleeding and pain than other treatment options. It is an option for men who cannot tolerate surgery or radiation or if the cancer has come back after radiation.
How well does cryotherapy work for prostate cancer?
Providers do not know how well cryotherapy works long-term to control cancer. There have not been many good research studies of how well it works compared to other available treatment options. For these reasons, it is not usually the first treatment offered.
Studies that have looked at focal cryotherapy (to one area) have found that it causes fewer side effects when compared to whole gland cryotherapy. But it is not clear if focal therapy works as well as whole gland therapy to treat prostate cancer and prevent it from coming back.
American Cancer Society. Cryotherapy for prostate cancer. https://www.cancer.org/cancer/prostate-cancer/treating/cryosurgery.html
Gestaut, M. M., Cai, W., Vyas, S., Patel, B. J., Hasan, S. A., MunozMaldonado, Y., … Swanson, G. (2017). Low-Dose-Rate Brachytherapy Versus Cryotherapy in Low- and Intermediate-Risk Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics, 98(1), 101–107.
Johns Hopkins Medicine. Cryotherapy for prostate cancer. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/cryotherapy-for-prostate-cancer
Jung, J. H., Risk, M. C., Goldfarb, R., Reddy, B., Coles, B., & Dahm, P. (2018). Primary cryotherapy for localised or locally advanced prostate cancer. Cochrane Database of Systematic Reviews, (5).
Mayo Clinic. Cryotherapy for prostate cancer. https://www.mayoclinic.org/tests-procedures/cryotherapy-for-prostate-cancer/about/pac-20384740
Shah, T. T., Peters, M., Eldred-Evans, D., Miah, S., Yap, T., Faure-Walker, N. A., … Ahmed, H. U. (2019). Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry. European Urology, 76(1), 98–105.