How Is Cryotherapy Used for Prostate Cancer?

Cryotherapy, also called cryosurgery or cryoablation, is a non-surgical treatment option that uses freezing cold temperatures to kill cancer cells. Cryotherapy is less invasive than surgery and typically has a shorter recovery process.^1,2

Cryotherapy may not be as effective when compared to radiation for advanced tumors. Cryotherapy can be used as a primary treatment option for localized prostate cancer, however, it can also be used for recurrent cancer that has not spread beyond the prostate.^1,2

What is cryotherapy?

Cryotherapy is a medical treatment. It is also called cryosurgery or cryoablation. It uses freezing temperatures to destroy cancer. Doctors use a gas to make the entire prostate, or part of the prostate, very cold. This creates a freezing temperature to kill the cancer cells and surrounding tissue.^1,2

Cryotherapy is a minimally invasive procedure. This means it uses small tools instead of large cuts. It may be a choice for people with localized prostate cancer. This means the cancer has not spread outside the gland.^1,2

What does the procedure entail?

Cryotherapy is performed under anesthesia and can often be performed as an outpatient procedure (meaning the treated individual can go home the same day).¹

The procedure utilizes several needles or hollow probes through the area between the anus and the scrotum. These probes are inserted using transrectal ultrasound (TRUS) guidance, meaning that the physician performing the procedure will use real-time images to make sure the probes are being inserted into the right location. Once inside the body, these images will further guide the probes to make sure the physician is treating the correct location as precisely as possible.^1,2

Freezing gas, typically argon gas, is circulated through the probes to freeze the cells that the probes are touching, as well as others nearby. A whole-gland cryotherapy procedure will aim to destroy the entire prostate gland, including the cancer cells, where focal cryotherapy, a newer technique, will aim to treat a small subsection of the prostate where the cancer cells reside.^1,2

It may be necessary to clear the bowels prior to the procedure using an enema. Additionally, to protect the urethra (the tube that carries urine out of the body) from freezing and losing function, warm salt water is circulated through it via a catheter during the entirety of the procedure. After the procedure, this catheter will typically remain in place for a few weeks, to ensure full emptying of the bladder during recovery.^1,2

It is common to have follow-up appointments every few months after the procedure. This is to ensure that the recovery process is going smoothly, to assess for any signs of recurrence, and to address any side effects that have developed. It is not uncommon to have a repeat biopsy of the area within a year after the procedure to further assess for recurrence.^1,2

What are the possible side effects of cryotherapy?

Advancements in ultrasound guidance and other techniques and tools used for this procedure have reduced the occurrence of serious side effects greatly. However, there is still a chance of developing some of the following issues post-procedure:^1,2

• Swelling of the procedure area, including the penis or scrotum
• Problems urinating including burning or pain, as well as developing the need to urinate more frequently
• Problems defecating, including developing the need to empty the bowels more frequently
• Urinary incontinence (loss of bladder control)
• Blood in the urine
• Erectile dysfunction

These are not all the possible side effects of cryotherapy. Talk to your doctor about what to expect with cryotherapy. You should also call your doctor if you have any questions or concerns about cryotherapy.

Other very rare side effects include injury to the rectum, infection of the pubic bone, or blockage of the urethra. Your doctor will assess your specific case and determine if cryotherapy is right for you, and what side effects you may be at risk for. They also may be able to provide you with information or other medicines to combat any debilitating or quality-of-life-altering developments after the procedure.^1,2

Other things to know about cryotherapy

Cryotherapy is not for everyone. It is usually for men with early-stage cancer. It also may be an option if cancer comes back after previous treatment. This is called salvage therapy. Doctors may not recommend it if the cancerous area is large, to avoid damaging other areas. It also may not be an option if you have had certain rectal surgeries.^1,2

There are 2 types of cryotherapy. Whole-gland therapy treats the entire prostate. Focal therapy treats only the area with cancer. Focal therapy may have fewer side effects. However, it is not yet clear if it works as well as treating the whole gland. Most people go home the same day or the next day. You will generally need to use a catheter to help with urination for a period of time while your body heals.^1,2

Talk with your doctor

Cryotherapy is an important option for prostate cancer. It uses cold to kill cancer cells without major surgery. It has a shorter recovery time than some other treatments. It also has specific risks like erection and bladder problems. Every person is different. You should discuss your medical history with your care team. They can help you decide if this treatment is right for you.^1,2