Prostate cryotherapy (Cryosurgery or Cryoablation) is a technology that freezes the prostate to destroy cancerous tissue. This technique is an outpatient minimally invasive procedure that involves placing a series of needs into the prostate while utilizing ultrasound guidance. Argon gas is then passed through the needles and the gland is frozen. While the prostate is being frozen prostate ultrasound is being performed that allows the simultaneous imaging of the prostate and monitoring the ice ball. The urethra is warmed during the procedure that helps preserve the integrity of the urethra and urinary continence. The procedures are usually performed as an outpatient.
The ice that forms ruptures and destroys cells. The destruction of this tissue occurs at the time of the treatment. Tumors rely on a blood supply and the ice damages the blood supply beyond its ability to repair itself. Lastly, the cryotherapy technique leaves a harmless scar behind after treatment.
So which patient is this technique best suited for? The ideal candidate for this type of prostate should have biopsy proven localized prostate cancer. The patient should have a reasonably sized prostate, and a PSA less than 10.
Prostate cryotherapy can now be offered to several different subsets of
prostate cancer patients including patients who have failed radiation therapy, patients who wish to undergo cryotherapy as a primary treatment of the entire gland and have organ confined disease, and now targeted cryoablation of the prostate can also be offered to patients who have localized disease. Newer imaging techniques that help localize disease, have also made targeted therapy easier to perform. Patients who have disease that would result in a high risk of positive surgical margins are also good candidates for this treatment. Patients who can not tolerate a surgical procedure may also be good candidates for this procedure.
The benefits of cryotherapy include no permanent radiation seeds and no radiation exposure. Unlike a radical prostatectomy, it is not major surgery, the recovery is very rapid and it may be performed with spinal anesthesia. Cryotherapy is also unique as it is repeatable if cancer again develops.
Technology that has been introduced by Endocare, one of the leaders in cryotherapy treatment utilizes planning and placement software that enables safe and effective treatments. Additionally the Endocare cryoprobes enable the delivery of variable lengths of ice better that better conform to the exact shape of the prostate. Monitoring the temperature of surrounding crucial stuctures such as the nerve supply of the prostate, the urinary sphincter and the rectal wall enables the protection of these important structures and results in a safe treatment. As technology has progressed, the side effects of this treatment has been greatly reduced.
When compared to other treatments such as radical prostatectomy or radiation therapy (seeds or external beam therapy), patients do very well. Review of the published literature demonstrates continence rates that are better than radical surgery, and similar to radiation therapy. One drawback to whole gland cryotherapy is higher rates of impotence, however targeted therapy will result in lower rates of impotency. Patients who have erectile dysfunction at the time of diagnosis, or whom potency is a low priority are thus ideal patients. Injury to the rectum is reported as being similar or superior to other prostate cancer treatments.
Patients who have recurrent prostate after radiation therapy have limited options for treatment. Cryrotherapy and salvage radical prostatectomy (surgery) are the only options that can be potentially curable. Hormone therapy can not cure the disease, but only delays its progression. Studies have demonstrated that there is little apparent difference in the efficacy of these two treatments. If the cancer is truly localized, both cryotherapy and salvage surgery will cure the patient of their disease, with cryotherapy being the least invasive alternative, however the side effects of rectal injury and incontinence have been shown to be far less common with the cryotherapy approach. Given the similar efficacy and decreased side effects, cryotherapy is an excellent minimally invasive alternative for these patients.
Published On: July 15, 2010