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Learning About Prostate Cancer Treatment

An exciting new development in prostate cancer treatment has occurred with cryosurgery, which is more aptly called "cryotherapy" today. Because it is minimally invasive, prostate cancer cryotherapy has fewer complications than surgery. The goals of minimally invasive therapies are:

To destroy the local disease
To shorten hospital stay
To reduce the number of postoperative morbidities
To shorten recovery time
To reduce the cost of the procedure

How is Cryotherapy performed?

The procedure is performed in the operating room, and the patient receives anesthesia. There is no incision; approx. six needles are inserted into the prostate to freeze the prostate and destroy all prostate cancer cells. During the procedure, the prostate and needle placement are evaluated with ultrasound imaging. Argon and helium gas circulates through the needles providing the doctor with controllable freezing and thawing capability. The temperature within the prostate is lowered to -40°C for several minutes, creating ice balls which kill cancer cells. The patient usually goes home that day and a urethral catheter drains urine into a bag on the thigh for one week.

Cryo Anatomy Diagram

The Benefits of Cryotherapy

The benefits of the procedure include a choice of general or regional anesthesia, a fast recovery and lower risk of potential side effects, such as incontinence. Cryotherapy does not involve radiation or radioactive substances (seeds) that are left in the body. And unlike radical prostatectomy, cryotherapy is not major surgery. This means that patients are back on their feet and back to their lives quickly. Recent studies have shown that for some men cryotherapy may be performed with minimal damage to the nerves necessary for sexual function. According to a study featured in the Journal of Urology October 2001, physicians, including Dr. Katz, conclude that cryotherapy is less invasive and causes less trauma and fewer side effects than radical prostatectomy.

Effectiveness of Cryotherapy

Reports show a 80% cure rate. Most studies have also shown significant decreases in the prostate specific antigen (PSA) in blood tests with no evidence of prostate cancer in repeat biopsies of the prostate after cryosurgery.

Are You a Candidate?

Choosing a treatment for prostate cancer isn’t easy. Today’s traditional choices include surgery, cryotherapy, radiation and hormone therapy. Each of these may be used alone or in combination. Whether you have first-time or recurrent prostate cancer, there’s a good chance you’re eligible for cryotherapy – as long as your cancer has not spread beyond the prostate. Of course, only a qualified doctor will know for sure.

Compare the Advantages of Cryotherapy
to Radical Prostatectomy

	Cryotherapy	Surgery (Radical Prostatectomy)
Treatment Description	1-2 hour minimally invasive procedure in which the prostate is frozen but not removed	2-3 hour procedure to remove the prostate
Recovery	Single day out-patient procedure or 1 night in hospital, resume normal lifestyle in 2-3 days	Usually 3 days in hospital followed by a 3-5 week recovery
Morbidity (Chance of)	Incontinence: 1.3² - 7.5³% Impotence: 22⁴ – 95⁵% Rectal Injury: 0² - 0.5³%	Incontinence: 7⁸ – 52⁹% Impotence: 14⁸ – 90¹⁰% Rectal Injury: 1⁹ – 3¹⁰%
Quality of Life Score - After Treatment (Max Score of 30)	Physical well-being: 26.1⁶ Social/family well-being: 21.9⁶ Emotional well-being: 18.1⁶ Functional well-being: 24.6⁶	Physical well-being: 25.4¹¹ Social/family well-being: 21.6¹¹ Emotional well-being: 16.6¹¹ Functional well-being: 20.9¹¹
Efficacy	Based on five and seven year published studies of PSA outcomes, cryotherapy and surgery provide similar cancer control for low risk prostate cancer. For moderate and high-risk disease, cryotherapy may provide superior cancer control over surgery.^{^2,7}

Compare the Advantages of Cryotherapy
to Radiation

While radical prostatectomy and radiation therapy are considered the “gold standard” treatment for localized prostate cancer, there is compelling evidence that both treatments provide less than optimal efficacy in the treatment of disease. In fact, cryosurgery may be an effective treatment when radiation fails. “For prostate cancer patients who fail radiation, the advantages of cryosurgery over radical prostatectomy are outstanding,” Dr. Katz told Urology Times, “A man in his late 60s with prostate cancer may not have a recurrence until he is in his late 70s. Why put a man in his 70s through major pelvic surgery?”

	Cryotherapy	External Beam or 3-D Conformal Radiation Therapy	Interstitial Radiation (Brachytherapy)
Treatment Description	1-2 hour minimally invasive procedure in which the prostate is frozen but not removed	6-8 week treatment where radiation is aimed at the prostate but also passes through healthy tissue	Permanent implantation of 80-100 radioactive pellets into the prostate
Recovery	Single day out-patient procedure or 1 night in hospital, resume normal lifestyle in 2-3 days	5 treatments per week for 6-8 weeks, up to two months of fatigue after full course of treatment	Single day out-patient procedure. Up to 3 months of residual pain and rectal problems
Morbidity (Chance of)	Incontinence: 1.3² - 7.5³% Impotence: 22⁴ – 95⁵% Rectal Injury: 0² - 0.5³%	Incontinence: 0⁹ – 15¹⁰% Impotence: 6¹¹ – 84¹¹% Rectal Injury: 13⁹ – 17¹⁰%	Incontinence: 0¹² – 19¹²% Impotence: 0¹¹ – 66¹²% Rectal Injury: 5.5¹³ – 19¹⁴%
Quality of Life Score - After Treatment (Max Score of 30)	Physical well-being: 26.1⁶ Social/family well-being: 21.9⁶ Emotional well-being: 18.1⁶ Functional well-being: 24.6⁶	Physical well-being: 24.9⁶ Social/family well-being: 21.6⁶ Emotional well-being: 17.3⁶ Functional well-being: 21.2⁶	Physical well-being: 25.4¹⁵ Social/family well-being: 14.9¹⁵ Emotional well-being: 21.3¹⁵ Functional well-being: 23.6¹⁵
Efficacy	Based on five and seven year published studies of PSA outcomes, cryotherapy and all forms of radiation provide similar cancer control for low risk prostate cancer. For moderate to high-risk disease, cryotherapy may provide superior cancer control over all forms of radiation.^2,5,7 Clinical studies consistently show that the negative biopsy rates following cryotherapy are lower than those for all forms of radiation.^2,5,7

Salvage Cryotherapy

To date, the gold standard therapies for clinically localized prostate cancer include radical prostatectomy, and radiation therapy (external beam and brachytherapy). Prostate biopsy and serum prostate specific antigen (PSA) data following these therapies suggest recurrent and residual disease rate ranging from 25% to 93%. However, some of these patients will be candidates for salvage therapy because of locally recurrent disease and a good health condition. The goal of these salvage therapies is to improve local control and possibly impact long-term survival. For patients who have radiation therapy failure, four therapies can be proposed: salvage prostatectomy or cystoprostatectomy (with high risk of complications), salvage brachytherapy, hormonal therapy and salvage cryoablation of the prostate.

Cryotherapy Myths & Facts

Myth: Cryotherapy is experimental.
Fact: Cryotherapy has been approved by the FDA, is covered by Medicare and has been performed on thousands of patients by hundreds of doctors nationwide each year.

Myth: Cryotherapy has serious side effects.
Fact: Years ago, patients suffered damage to the urethra and surrounding tissue because doctors lacked the right imaging technology and temperature monitoring tools. But today, ultrasound technology guides both the probe placement and the freezing process. In addition, temperature sensors and a urethral warming system ensure that surrounding tissue, including the urethra, does not get too cold.

Myth: Cryotherapy doesn’t work.
Fact: A recent study showed that 97.6% of patients treated with new-generation minimally invasive cryotherapy were still cancer-free after twelve months. Long-term follow-up data using the ultra-thin 17-gauge needle technology is not yet available, although open studies with cryotherapy have demonstrated up to 95% of survival at seven years.

Myth: Cryotherapy is expensive.
Fact: Cryotherapy costs far less than a radical prostatectomy. It is covered by Medicare, as well as most insurance plans and VA hospitals, making it accessible and affordable for virtually any patient.

Risks of Cryotherapy

The main risk associated with prostate cryotherapy is impotence. This may occur since in order to insure the destruction of all cancer cells, the goal is to freeze tissue beyond the prostate. In doing so, nerve bundles associated with erection may be affected. However, these nerves can regenerate and depending on potency prior to cryotherapy, it may return over a period of time. In a recent study, doctors found that at three years after cryosurgery, patients’ reported quality of life was not worse than that of men treated with radiotherapy, radical prostatectomy, brachytherapy or with being observed. The only exception was erectile dysfunction, which improved with the use of aids and the passage of time.

Side Effects of Cryotherapy

In some patients, incontinence or urethral scarring may be a side effect following cryotherapy. In most cases the symptoms are resolved in a few weeks. Other possible side effects include: