Putting the Freeze on Cancer With Cryotherapy

By Jim Preen

3 min read

During the summer of 2022 I learned my friend Les had been diagnosed with prostate cancer. Eagle-eyed readers of this website may remember I wrote an article titled "A Friend Phones With Bad News" where we left Les considering either brachytherapy or cryotherapy to treat his condition.

To refresh your memory, his prostate cancer was discovered relatively early. He had been on active surveillance, so when the bad news came, the cancer had not spread outside the prostate. His PSA stood at 5, and his combined Gleason was 7.

To cut to the chase, Les decided to go with focal cryotherapy, so a brief look at this not-so-well-known treatment seems in order.

What is cryotherapy?

There are two types of cryotherapy: whole prostate and focal. As the names suggest, the former targets the whole prostate and the latter just the cancerous area. Both take place under general anesthesia. Cryotherapy is generally offered if the cancer has not spread outside the prostate. This treatment tends to be less invasive than others, such as surgery.¹

Cryotherapy involves thin needles being put through the perineum, the area between the anus and scrotum. Freezing gases can then be passed through to freeze and kill the cancer cells. A warming catheter is also used to protect the urethra (the tube that carries urine out of the body) from the cold temperatures, which can drop to nearly -40°C.¹

Les had two cryotherapy treatments, one immediately following the first.

What others shared about the procedure

A few days before his treatment began, Les sent me a note asking for a little help. He wanted to know if any of the people who read my articles had undergone focal cryotherapy and what their experience had been a few days after the procedure.

I posted his question on various forums. Typically, when you ask about prostate cancer online you get a deluge of responses. Not this time, but fortunately I got a couple useful replies. They mentioned mild soreness or some fatigue after the procedure, but also good results with their followup PSA levels (they had dropped).

So relatively comforting thoughts from those who had frontline experience of the treatment.

My friend's experience

On the day of his procedure, Les was admitted for surgery at 10:30 a.m., had the 90-minute operation, and was released from the hospital later that afternoon. He had a catheter inserted that allowed him to pee into a bag.

If the bladder is not working correctly, bacteria can find its way back into the kidneys and cause an infection.² Les knew he was going to be told to drink a great deal of water and took incontinence pads to the hospital, which he continued to use for several days after the event.

The catheter was removed eight days later, but not before he had to endure a great deal of pain.

Pain after the procedure

Initially, everything was fine. He had the op on a Wednesday, but by Friday he was suffering cripplingly painful bladder spasms. I asked whether this was mentioned as a possibility before he was sent home.

He replied: The Consultant may have mentioned it after the op - I was still a bit spaced out due to the anaesthetic - but the discharge team didn’t mention it.

Unfortunately, he was unable to get any meds until the Monday afternoon, leaving him in severe discomfort over the weekend. Once taking a drug (Mirabegron or Betmiga) to relax his bladder muscles, he felt better within a few hours.

Latterly his consultant told him the bladder spasms were caused by the catheter and are not a common side effect.

Still happy with his decision

Looking back, and despite the pain he had to endure, Les is happy with the treatment he chose but suggests having the bladder-relaxing pills on hand should the spasms start.

He has had a post-op MRI scan, and his consultant says his prognosis is good. He will now have six monthly tests and check-ups.

Given there is not a ton of long-term data on cryotherapy, I’d like to hear from others. For those lucky enough to catch prostate cancer early, it may be a treatment whose time has come.

Have you had cryotherapy? If so, how did it go, and what side effects did you experience? Let us know in the comments below.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The ProstateCancer.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Richard Faust Community Admin
Hi <inline-mention username="Jim Preen" user-id="3263248"/>. I'll be very interested to hear how things go for your friend. One of the big issues with cryotherapy to this point is simply the lack of significant studies. I found this relatively small study from UCLA (61 patients) which looked at intermediate risk prostate cancer and found 80% success at 18 months, 10% "minor residual cancer, and 10% failure: <a href='https://www.uclahealth.org/news/ucla-researchers-find-cryotherapy-as-an-effective-treatment-for-men-with-intermediate-risk-prostate-cancer' target='_blank' rel='noopener noreferrer ugc'>https://www.uclahealth.org/news/ucla-researchers-find-cryotherapy-as-an-effective-treatment-for-men-with-intermediate-risk-prostate-cancer</a>. I found this study interesting for looking at intermediate risk where cryotherapy is usually discussed and researched for low risk. Do you know if your friend paid out of pocket? I ask because, due to the lack of studies, cryotherapy is deemed experimental and usually not covered by Medicare or insurance. I did notice a number of clinical trials taking place, which could potentially change this in the future. Wishing your friend the best. Richard (ProstateCancer.net Team)
1. Jim Preen Moderator & Contributor
 <inline-mention username="Richard Faust" user-id="3268931"/> Thanks for your comment. In answer to your question, Les had his treatment on the NHS in the UK so didn't pay for treatment. I'm really not sure why this form of treatment is so under used, perhaps it's only applicable in a limited number of cases. Les is keen to have his story told so I'll provide updates!
flutelawyer Member
I was diagnosed with non-metastatic prostate cancer (confirmed by an abdominal scan and a bone scan - both tests a requirement to qualify for the procedure) in the summer of 2021 and underwent partial gland cryo-ablation at NYU-Langone in October 2021. My tumor was at the front of my prostate so it was away from the nerves at the rear of the gland that control sexual function. I was in the operating room for about 75 minutes and when I awoke I only needed one 5 mg oxycodone for pain, The rest of the time pain was controlled by extra-strength Tylenol. I live in western MA so we stayed at a NYC hotel for the hospital procedure and the post-op follow-up. I had my procedure on a Tuesday and was discharged "home" with a catheter and was seen on the immediately following Friday to check bladder function and passing all the tests, the catheter was removed and I was discharged home. Because of the warm water bath circulating through my urethra and bladder, these physiological structures were stretched a little and it took time for them relax and shrink back to their normal size. As that happened my ability to control urination returned to normal. Because of where my tumor was located, sexual function has been preserved (even with only half a prostate!) although my ED has been aggravated, but that too seems to be slowly getting better. At six months post-op I had an MRI, a PSA and a post-op prostate biopsy. The PSA was below 0.50 and the pathologist could find NO EVIDENCE OF DISEASE. This means no detectable cancer - it does not mean the absence of cancer because of the granularity (level of resolution) of the test. At one year my PSA was below my six-month level and it is still declining. I am on a follow-up schedule of a PSA every six months, a yearly MRI and a prostate biopsy at five years unless sooner indicated. I am participating in a longitudinal study.
Jim Preen Moderator & Contributor
Sounds like a very good outcome. I too am part of the NED squad, long may we remain there! Jim
JoeGBrooklyn Member
I, too, had focal cryoablation surgery for my prostate cancer at NYU Langone Medical Center in July 2022. I was formally diagnosed in May of 2022 following gradually increasing PSA scores (highest was 5.1) and after a prostate biopsy (Gleason score of 3+4=7). Fortunately, my cancer was detected early and was contained within the prostate capsule, so I was a decent candidate for cryoablation. This procedure felt like a great alternative to me vs total prostatectomy or radiation, because it's been associated with a lower risk of unwanted quality-of-life side effects such as ED or urinary incontinence. My surgery lasted approximately 2 hours (they froze 2 or 3 different cancerous spots of my prostate) and I was released from the hospital that same afternoon. Luckily I had only minor pain (controlled by Extra Strength Tylenol) and no bladder spasms. My greatest discomfort was caused by the Foley catheter, which I wore for 4 nights. My surgery was performed on a Monday and my catheter was removed that Friday--much to my relief. For the first couple of weeks following surgery I had minor bleeding and urinary leakage (as well as some blood in my urine)--all of which were considered normal and resolved totally within 6 weeks. Since then I've been totally continent and have been able to experience normal erections. My 6-month PSA decreased by over 90% to 0.45. At the 1-year mark, my follow-up MRI showed no signs of cancer, though my PSA rose slightly to 0.7. Since I, too, am participating in a longitudinal clinical study, I will need to be followed every 6 months for PSA testing--with MRI or biopsy available at certain milestones if and when needed. I'm aware that my decision not to have my entire prostate removed may put me at a slightly higher risk of recurrence, though I've been told that in patients with cryoablation to date the recurrence rate has only been about 15%. This was a risk I was willing to take at this point in my life in order to give me the best chance at preserving my current quality of life. I hope this information is helpful. 
1. Jim Preen Moderator & Contributor
 <inline-mention username="JoeGBrooklyn" user-id="4693102"/> Joe, thanks very much for taking the time to tell your story. Without wishing to tempt fate, it sounds like a really good outcome. Having been on hormone therapy for a fairly gruelling thee years, one operation sounds like a great alternative. I too am on six monthly checks so I wish you well and let's hope our PSA level stays where it should! Jim
2. JoeGBrooklyn Member
 <inline-mention username="Jim Preen" user-id="3263248"/> Quick correction to my post above. My first post-surgical PSA of 0.45 was at 3 months after surgery. The clean MRI and PSA of 0.7 were at 6 months post-surgery. The mental and physical stress of it all just makes it feel like it's been a year! Overall, I've been happy with my treatment decision. Of course there are no guarantees. Here's hoping for continued "acceptable" PSA levels and good health!
Dennis E. Golden Moderator & Contributor
Richard Faust As always nice work on finding that informative research article!!! It will be interesting to see how this treatment evolves along with gathering additional information on its long term impact and patient quality of life issues. At this point it appears promising for that group of men who meet the treatment eligibility parameters. Dennis(ProstateCancer.net TEAM)

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