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Q. What is prostate cryosurgery?
A. Cryosurgery of the prostate means freezing of the prostate to eradicate cancer. This procedure is currently being performed in a minimally invasive way by inserting specialized “cryoneedles” into the prostate via the perineum (the small space between the prostate and the anus) This needles are inserted, and the freezing process is monitored, in a very precise way using ultrasound guidance. Temperature sensors also are used to guide the process. There is no incision needed. The procedure can be done under general or spinal anesthesia and it takes about an hour. Patients usually are discharged from the hospital the same day as the procedure or the following morning.
Q. What are the risks, complications and potential benefits of cryosurgery?
A. As cryosurgery has evolved over the past 15 years, there has been a significant drop in the risk of complications associated with the procedure historically. Incontinence occurs in less than 2% of patients treated, although the risk is higher in patients who have had previous radiation to the prostate. Damage to the bladder or rectum occurs in less than 1% of cases. Impotence is quite common after cryosurgery (approximately 80% chance) though newer protocols are being developed to address this issue in selected patients.
Q. How long will I have to be in the hospital?
A. The average length of stay for our patients is one day. Some patients can even go home the same day as the surgery. Immediately after surgery, you are taken to the recovery area and monitored until we determine that you can safely return to your regular room. Most of our patients are able to eat a small meal that same night. You can get up and move about.
Some patients with have a suprapubic tube, a small tube below the belly button to drain urine after the procedure. This tube will be removed at a subsequent office visit, and you will be taught how to use this tube before discharge. Other patients with have a Foley catheter – the type of tube that exits the penis. This type of tube will also be removed in the office.
Q. What about follow-up testing?
A. We recommend a PSA blood test every three months after cryosurgery for the first two years and then every six months after that. Sometimes a follow up prostate biopsy will also be recommended. Tests such as bone scans and CT scans are ordered on an as needed basis.
Q. How successful is cryosurgery?
A. Prostate cryosurgery appears to have very similar long term results compared to external radiation or brachytherapy. The odds of being cancer free ten years after treatment appears to be about 81% for low risk patients, 74% for intermediate risk patients, and 46% for high risk patients. These percentages refer to patients treated with cryosurgery only, and increase when other treatments are added in combination.
Q. What type of patient is a good candidate for cryosurgery?
A. In our experience with cryosurgery, we have found that this procedure often works well in patients who are at high risk of failing more conventional treatments. Such patients include those with large, bulky tumors (Stage T3), patients with high-grade tumors (Gleason score 8, 9 and 10) and in patients with a high initial PSA, such as greater than 15. Cryosurgery is often used in combination with other treatments for high risk patients to improve odds of success. Cryosurgery is also often used for patients who have failed radiation therapy.
Pros & Cons
|A minimally invasive treatment with rapid return to normal activities||Chance of cure is less well proven over a 10 year period that with other treatments|
|Is often effective in advanced Prostate Cancer (when other treatments are less effective)||Chance of impotence is high with cryosurgery|
|Very few urinary side effects||PSA may not be zero, and may fluctuate as with radiation options|
|Can be repeated, and doesn't preclude any type of future treatment||Quality of results can be highly dependent on experience of surgeon and institution|
|Can be used in cases of Seed Implant failure or Radiation failure|