Cryotherapy for Prostate Cancer

What is cryotherapy?

Cryotherapy uses extreme cold to freeze and destroy neoplastic prostate cells.

This is a minimally invasive technique that is very effective and has good results in treating localised prostate cancer or tumours with low or medium risk of spreading. It is also successfully used to treat recurrences of prostate cancer – for example after external radiotherapy, surgery or brachytherapy.

This therapy uses special needles through which a liquid gas, normally argon, circulates, allowing a controlled application of extreme cold to the prostate and destroying the cancerous tissue.

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What is the Cryotherapy Procedure?

Cryotherapy involves using general anaesthetic or spinal anaesthetic. No pain or discomfort is felt at all.

If your prostate is too large, the doctor may advise prior treatment to reduce it before cryotherapy.

The specialist inserts probes (needles) into the skin between the scrotum and anus.

As the procedure is performed in real time and controlled by ultrasound and temperature, it uses sophisticated equipment and software.

Extremely low temperatures are created at the ends of these needles which generate ice “balls” (-40ºC).

Cancer cells are more sensitive to freezing/thawing, so they can be destroyed by cold.

To ensure the tumour is eliminated but no tissue adjacent to the prostate is damaged, a catheter is inserted into the urethra through which a heated liquid is introduced.

This ensures that the urethra (through which the urine is removed from the body) does not freeze nor is affected by the cold.
Sensors are also used to show the temperature at various points (inside the prostate, at the sphincter and on the kidney wall) to ensure the safety of the procedure.

Indications

Until recently, cryotherapy was only recommended for locally advanced tumours or after other techniques had failed. For example, when a local recurrence occurred after surgery, radiotherapy or brachytherapy.

However, due to its effectiveness, its use was extended to treat some localised prostate cancers. It can be used on the whole gland or in just specific tumorous areas – in which case it is called focal therapy.

Cryotherapy is a suitable viable option for treating men with low-risk, early-stage prostate cancer who cannot or don’t want to undergo surgery or radiotherapy.

Despite good results, cryotherapy is rarely the first choice in treating prostate cancer.

Want to know more about this treatment?

Cryotherapy is a very effective option with good results in treating localised prostate cancer or cancer with low to medium risk of spreading.

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What is the Post-Treatment Like?

Most patients can return home the day after treatment or on the same day.

Some discomfort or pain is normal. If restrictive, the doctor can prescribe medication to relieve these passing symptoms.

Secondary effects tend to be greater in patients submitted to earlier treatments, for example after radiotherapy or brachytherapy.

Undesired symptoms are normally related to lesions on the prostate or adjoining structures and can include blood in the urine due to the catheter, temporary pain at the spot where the needles were inserted and temporary oedema of the penis, from the scrotum or perineum.

Cryotherapy can cause urinating difficulties and incontinence, but these tend to vanish with time. They depend on how each patient responds to treatment. However, the probability these complications will occur is greater when cryotherapy is the second treatment used (i.e. a saviour treatment due to recurrence after another treatment). Erection issues may also occur, like in other prostate cancer treatments.

After treatment, blood tests are performed to gauge the PSA (prostate-specific antigen) levels that are an indicator of the treatment’s effectiveness.

The doctor may suggest imaging tests after the procedure to discover if the cancer has been totally eliminated.

Post-operative follow-up consultations depend on each patients’ clinical situation. The doctor will develop a personal plan based on each patient’s specific characteristics which must be followed if undergoing this treatment.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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