Cryosurgery is a procedure that uses extremely cold temperature to freeze-kill cancer cells. This is also called cryotherapy or cryoablation. Cryosurgery is usually employed in the early stages of prostate cancer. Cryosurgery is not a suitable treatment option for men who have large prostate glands as it may not be possible to treat all of the necessary areas using this technique.
Hollow needles or probes are passed through the skin between the anus and the scrotum and guided towards the prostate using transrectal ultrasound (TRUS). Usually, spinal or epidural anesthesia is used to make the patient numb below the waist for this procedure.
After successful placement of the needles, very cold gases are passed though the probes that creates balls of ice that can kill prostate cancer cells. Close monitoring with TRUS ensures that neighbouring structures and organs are not damaged by the cold. During the procedure, warm saline water is circulated through a catheter inside the urethra to protect it from the freezing cold. After surgery, this catheter remains in place for up to three weeks to allow the bladder to empty while the patient recovers.
After the cryosurgery, some bruising or soreness is usually felt in the area where the probes were placed and there may also be blood in the urine. The penis and scrotum may be swollen and the patient may feel pain and a burning sensation within the abdomen, as well as an urge to frequently empty the bowels and bladder. Freezing can also cause nerve damage that can lead to erectile dysfunction. An overnight stay at the hospital may be recommended or the patient may be allowed to go home the very same day of the operation.
Advantages and disadvantages
One of the advantages of cryosurgery over radical prostatectomy is that it does not lead to as much blood loss. Furthermore, the degree of post-operative pain is much less and patients take far less time to recover in hospital. However, cryosurgery is a relatively new approach to prostate cancer and less is known about how effective it is in the long-term compared with prostatectomy or radiotherapy.
Reviewed by Sally Robertson, BSc