Cryosurgery, also known as cryotherapy or cryoablation, is recognized as one of the established minimally-invasive treatment options for localized prostate cancer.

Cryosurgery uses small needles (similar to the ones used to draw blood) to form ice balls that are up to five centimeters in length. These extremely cold temperatures are able to kill prostate or kidney cancers. Several studies reported an acceptable oncological outcome and low morbidity.

Prostate Cryosurgery

For the prostate cryoablation procedure, the patient is placed in a lithotomy position under general or spinal anesthesia and a Foley catheter is placed in the urethra.

Using transrectal ultrasound guidance, 17-gauge cryoprobes are sequentially placed through a special guidance template into the prostate. Appropriate needle positioning is verified by ultrasound image.

A thermocouple is placed at the level of the urinary sphincter and a urethral warming catheter is placed to maintain a temperature of approximately 42°C during the procedure. The urinary sphincter is maintained at temperatures greater than 0°C in an attempt to avoid urethral complications.

Potential Benefits and Drawbacks of Cryosurgery

These apply to populations of patients in general, but the individual patient may have a different experience.

• Often minimally invasive
• Usually can be repeated, if necessary
• Outpatient (prostate patients) or overnight observation (kidney patients)
• Usually minimal pain
• Often quick recovery to normal activities
• Generally effective cancer treatment for selected patients
• Mostly minimal side effects
• High patient satisfaction rate
• Targeted therapy, under image guidance

One of the main drawbacks of total prostate cryotherapy is erectile dysfunction. The nerve bundles that cause penile erections get frozen during the procedure and can be damaged.

Who Is a Candidate for Prostate Cryoablation?

For primary cryoablation patients

“Primary” represents the patient who has been diagnosed with prostate cancer but has not been previously treated.

The ideal candidate for primary prostate cryoablation a man with cancer contained within the prostate. Since cryosurgery generates extremely cold temperatures, it is usually able to kill early tumors and those with aggressive features (e.g. Gleason score 8-10).

For salvage cryoablation patients

“Salvage” represents the patient with a rising PSA after receiving definitive primary therapy, including, external beam radiation therapy, brachytherapy, HIFU, and also cryotherapy.

Patients may be considered candidates for salvage cryoablation as long as: biopsy-proven recurrent prostate cancer is confirmed; the cancer is believed to be confined to the prostate; and the patient is an operative candidate.

Candidate selection for salvage cryosurgery is critical and involved additional tests to determine of the recurrent cancer is still likely confined or may have spread.

This may involve:

• Ultrasound directed prostate biopsies¹
• Biopsies of the seminal vesicles¹
• Endorectal coil MRI
• Blood tests
• Pelvic lymph node dissection

¹ Any biopsies done outside of Duke University Medical Center must be confirmed by a qualified pathologist. If you elect to have your treatment here, both biopsies and x-rays are best performed at Duke University Medical Center.

Learn more about prostate cancer:

• Focal Therapy for Prostate Cancer
• Prostate Cancer Facts
• Types of Prostate Cancer