Am
I a candidate for cryosurgery?
The patients that I believe are the best candidates
for cryosurgery are those with:
• localized prostate cancer
• radiation recurrent disease
• high-risk prostate cancer (elevated PSA >10 and a
Gleason's score of 7 and above)
Also, I have recently started treating patients
with low risk prostate cancer in the focal manner. Focal
cryosurgical ablation appears to be well suited for patients
with early stage prostate cancer who have a minimal amount
of prostate cancer localized to one area of the gland.
I have had radiation
therapy. Can I have cryosurgery?
The answer to this question is a definite yes.
The majority of my patients, nearly 70% of my
practice, are patients that have had previous radiation therapy,
either external beam or seed implantation, or a combination,
and have had a biopsy proving recurrence in the prostate gland.
The overall side effects in my experience are
minimal but there can be some incontinence, although this
has been reported as less than 5% of the patients. In my own
experience, 97% of my patients are still alive after 10 years
with salvage cryosurgery and I feel that this is an excellent
modality for patients with this type of disease. The only
other options for these patients would either be hormonal
therapy, watchful waiting, or to consider a salvage radical
prostatectomy. However, I feel that a salvage radical prostatectomy
offers no statistically significant increase in overall survival
and may be fraught with a higher complication rate even in
experienced hands.
How long will I be in
the hospital?
Cryosurgery is now mostly an outpatient procedure.
Over the past two years, I have changed my approach
to discharging patients. In the past, I had kept all the patients
overnight but now all of my patients go home. I do not feel
that there is any need for hospitalization at this time. There
is no real bleeding or pain or any fluid shifts, and therefore
patients can go home following the procedure. You should understand
that when you do go home you will have either a Foley catheter
in the bladder or a suprapubic tube for at least 5 days after
the procedure, and our nursing staff here at the hospital
will teach you how to take care of this catheter. While you
have the catheter in, you can still go outside, you can drive
a car, you can even go to restaurants.
Will my insurance cover
cryosurgery?
Thankfully, as of several years ago, Medicare
has approved cryosurgery as both a primary and salvage procedure,
and Medicare will also cover the brief hospitalization. In
my practice, we do take other commercial carriers and you
should call my office to find out if you are under those plans.
If not, we will work with your insurance carrier to help pay
for the procedure; however, there will be an upfront cost
to you. In the majority of my patients, 80% of our fee is
reimbursed to you by your insurance carrier.
How many procedures has
Dr. Katz done?
I feel that I am an expert in cryosurgery and
I have performed over 400 cryosurgeries to date. I have performed
cryosurgery not only in the United States, but also in Europe.
I have trained well over 100 physicians in this procedure.
What kind of anesthesia
will I have?
The majority of my patients have cryosurgery
under spinal anesthesia. I do not feel that general anesthesia
is required. I feel that with spinal anesthesia the patients
recover quickly, they feel no pain, and do not have the long-lasting
sedative effects of general anesthesia.
Will my potency be affected?
In the past, cryosurgery had the highest risk
of impotence, nearly 100%. This is still true today, especially
if cryosurgery is performed in a manner where the gland is
completely frozen; however, recently we have added the temperature
monitoring devices in the neurovascular bundles to monitor
the temperature. If you have low risk prostate cancer or have
unifocal disease, the neurovascular bundles can be preserved
and potency can be maintained. Even if cryosurgical ablation
is required and complete ablation is performed, there has
been regrowth of nerves in this area and a subset of our patients
have had return of their sexual function, especially when
using oral agents such as Viagra, Levitra, or Cialis.
I have unifocal disease.
Is there a "nerve-sparing" cryosurgery?
The concept of focal cryosurgery is to freeze
that area of the involved prostate gland and leave the other
side unfrozen. This has the potential advantages of causing
no urinary or sexual dysfunction, but may leave unfrozen prostate
cancer on the other side. Even if the biopsy did not reveal
cancer, there can still be areas of small cancer that were
not detected on biopsy. Therefore, I recommend that if you
are considering focal cryoablation that you should have a
thorough consultation in my office and also have a follow-up
biopsy 1 to 2 years after the procedure.
Has Dr. Katz published
anything?
Yes, please see this website. We have our research
published in the area of primary and salvage cryotherapy.
When can I drive or go
back to work or exercise?
The majority of my patients can drive within
a day or two and go back to work in one to two weeks.
Even though they have a catheter in the bladder,
the catheter is connected to a leg bag which is placed around
your thigh and the urine is collected in this bag. It is possible
for you to drive a car or go out to restaurants at this time.
In terms of going back to work, this depends upon the amount
of physical exercise and physical energy that is required
at your job. If you have a desk job the majority of the patients
can return to work in one week. If your job requires more
physical labor, then I would recommend at least two weeks
from work.
Compared to radical surgery,
how invasive is it?
The idea behind cryosurgery is to place small
needles through the skin and into the prostate and freeze
the cancer. This will kill the cancer. This procedure is noninvasive
in that it does not require an incision, there is no bleeding.
The procedure is monitored under ultrasound and small temperature
devices are placed in and around the prostate gland to monitor
the temperature and insure that the entire gland is ablated.
What kind of follow-up
is there?
In terms of follow-up, following cryosurgery
patients return to my office in 5 to 7 days to have the catheter
removed. Once this is removed I see the patients back in 2
to 3 months and obtain a PSA and do a physical examination.
I recommend that all of our cryosurgical patients have a physical
examination and PSA every 4 months for the first 2 years,
and then every 6 months thereafter. There is no need for additional
biopsies (unless you have focal cryosurgery, see above or
if the PSA should rise). If the PSA does rise, and has risen
three times in a row, then I would recommend a repeat prostate
biopsy.
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