Cryoablation of prostate

Cryotherapy is another way to treat localized prostate cancer in men. Also known also as cryoblation or crysurgery, this relatively new procedure destroys cancer by freezing it.

After spinal, epidural, or general anesthesia is administered, an ultrasound probe is inserted into the rectum to image the prostate. A small tube (suprapubic catheter) is placed into the bladder through an small puncture in the abdominal wall just above the pubic bone. This catheter allows urine to be drained from the bladder when the prostate swells after the procedure.

Hollow needles are inserted through the skin of the perineum, the area between the anus and the scrotum. Once the needles are in place, extremely cold gas is passed through the needles. The gas is cold enough to create ice balls, which destroy the prostate by freezing the gland as well as any cancerous cells within it. To keep the urethra from freezing, warm saltwater is circulated through a special catheter (urethral warmer) in the urethra. During the procedure, the doctor monitors the procedure by the ultrasound images of the ice ball, as well as temperatures from thermal probes. Cryotherapy is generally performed as an outpatient in ambulatory surgery.

Any swelling of the scrotal sac, soreness, or bruising will take a few days to diminish. Once swelling of the prostate has subsided, usually after 1 to 3 weeks, the suprapubic catheter may be removed. 

Possible side effects of cryotherapy

• Blood in the urine for a few days after the procedure
• Soreness of the perineum
• Swelling of the penis or scrotum
• Pain and burning sensations
• A need to empty the bladder and bowels more often
• Impotence (common) 
• Urinary incontinence (very rare) 
• Urethral tissue slough with obstruction (very rare)

Advantages of cryotherapy

• Transrectal ultrasound provides accurate monitoring of the ice ball during freezing
• Outpatient surgery under spinal or general anesthesia
• Rapid recovery
• PSA drops to low level in 6-8 weeks, so good idea of result of treatment early
• May repeat treatment if cancer recurs or persists
• Less invasive than radical prostatectomy
• Negligible blood loss
• May treat only the one side with cancer in patients with minimal disease (focal therapy), sparing erectile function

Disadvantages of cryotherapy

• Shorter long-term patient follow-up compared with other therapies
• Urgency to urinate for roughly three weeks
• Need for suprapubic catheter to drain bladder for three weeks post operatively
• Impotence in most patients with the potential of reversibility

Cryoablation of prostate
Freezing treatment of prostate cancer using small probes placed through the perineal area with transrectal ultrasound guidance, similar to brachytherapy.  Temperature probes monitor the freezing process, protecting the rectal wall and external urinary sphincter.   A urethral warming catheter prevents urethral injury and tissue sloughing.  A suprapubic catheter may be used drain the bladder for a couple of weeks until the prostate swelling resolves.