Cryotherapy

Urologists around the world perform minimally invasive procedures with cryosurgery including prostate cancer and renal cancer with cryotherapy guided and monitored with ultrasound. New cryo applications are currently being developed for ablation treatment of liver metastases as well as other malignant and benign tumors and palliative interventions. Cryosurgical treatments for tumors are often performed by Interventional Radiologists (IR) using imaging modalities such as CT and MRI.

The Freezing Process

Cryotherapy systems use compressed Argon gas through the Joule-Thomson effect to produce extremely low temperatures. As the gas passes through cryoablation needles, the tip of the needle is cooled, forming an iceball, which engulfs the tumor and destroys the tissue.

The basic principles of cryosurgery for tumors are fast cooling of the tissue to a lethal temperature, thawing, and repetition of the freeze-thaw cycle. Further research is continuously being conducted to better understand the cellular mechanisms involved in cryosurgery in order to increase the efficacy of cryosurgery for specific tumor ablation.

CRYOTHERAPY FOR PROSTATE CANCER

A minimally invasive treatment that uses ice to destroy prostate cancer

Cryotherapy (also called cryoablation and cryosurgery) is a minimally invasive treatment option for patients with all forms of prostate cancer that has not spread. This treatment is also an option for patients who’s prostate cancer has returned following radiation treatment (salvage cryotherapy). Cryotherapy is most popular among men who want to avoid either major surgery or radiation treatment.

Cryotherapy is unique in that it uses extreme cold to destroy prostate cancer. During the procedure doctors guide ultra-thin needles into the prostate. Once in place, argon gas is circulated inside the needles creating ice that freezes the prostate tissue and destroys the cancer. During the freezing process the cryo needles are precisely controlled and monitored. As the ice forms, both temperature monitoring and ultrasound visualization is used to verify accuracy and safety while a warming catheter is used to protect the urethra.

Cryotherapy is FDA-cleared and is covered by Medicare and most private insurance companies. The procedure takes around two hours. Its typically performed as an “outpatient” procedure meaning no long hospital stay. Cryotherapy can be performed using general or local anesthesia. Recovery time is fast. Patients are typically back on their feet in a few days. And most patients report little or no pain during their recovery.

Cryotherapy has one of the lowest incidence of incontinence. However, it carries a higher risk of impotence. That’s because in order to destroy all cancer cells, doctors may need to freeze beyond the prostate. If so, the nerves associated with an erection can be impaired.

Prostate Cryotherapy Following Radiation Treatment

Cryotherapy performed on men who have recurrent prostate cancer, having failed radiation therapy, is referred to as salvage cryotherapy. This treatment may be combined with hormonal therapy. In some cases cryotherapy may provide a curative outcome thereby avoiding the need for ongoing hormonal therapy.

Advantages of Cryotherapy

• Minimally invasive, involving only insertion of the cryo needle through the skin
• Pain, bleeding, and other complications of surgery are minimized
• No radiation seed or radiation beams
• Ice is a natural and repeatable treatment
• Less expensive than other treatments
• Short recovery time and typically a short or no hospital stay
• Procedure can be done using with general or local anesthesia
• Can be targeted to destroy only the cancer and spare healthy prostate tissue
• If needed the procedure can be repeated multiple times

Appropriate Candidates

• All men with localized prostate cancer (not spread)
• Men with primary prostate cancer (first treatment)
• Men with prostate cancer that has returned after radiation (salvage)

Side Effects

• Cryosurgery may cause incontinence (lack of control over urine flow); often, these side effects are temporary
• Higher chance of impotence (loss of sexual function)
• In some cases, the surgery has caused injury to the rectum although the reported incidence is less than 1%