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Cryotherapy (also called cryosurgery or cryoablation) is the use of very cold temperatures to freeze and kill prostate cancer cells as well as most of the prostate. Even though it is sometimes being called cryosurgery, it is not actually a type of surgery.
Cryotherapy is sometimes used if the cancer has come back after radiation therapy. It may be an option to treat men with low risk early-stage prostate cancer who cannot have surgery or radiation therapy. However, most doctors do not use cryotherapy as the first treatment for prostate cancer..
This type of procedure requires spinal or epidural anesthesia (the lower half of your body is numbed) or general anesthesia (you are asleep).
The doctor uses transrectal ultrasound (TRUS) to guide several hollow probes (needles) through the skin between the anus and scrotum and into the prostate. Very cold gases are then passed through the needles to freeze and destroy the prostate. To be sure the prostate is destroyed without too much damage to nearby tissues, the doctor carefully watches the ultrasound during the procedure. Warm saltwater is passed through a catheter in the urethra during the procedure to keep it from freezing. The catheter is left in place for several weeks afterward to allow the bladder to empty while you recover.
After the procedure, you might need to stay in the hospital overnight, but many men go home the same day.
Cryotherapy is less invasive than surgery, so there is usually less blood loss, a shorter hospital stay, shorter recovery period, and less pain. But compared with surgery or radiation therapy, doctors know much less about the long-term effectiveness of cryotherapy. And as with brachytherapy, this may not be a good option for men with large prostate glands.
Side effects from cryotherapy tend to be worse if it is done in men who have already had radiation therapy, compared to men who have it as the first form of treatment.
Most men have blood in their urine for a day or two after the procedure, as well as soreness in the area where the needles were placed. Swelling of the penis or scrotum is also common.
Freezing might also affect the bladder and rectum, which can lead to pain, burning sensations, and the need to empty the bladder and bowels often. Most men recover normal bowel and bladder function over time.
Freezing often damages the nerves near the prostate that control erections. Erectile dysfunction is more common after cryotherapy than after radical prostatectomy. For information on coping with erection problems and other sexuality issues, see Sexuality for the Man With Cancer.
Urinary incontinence (having problems controlling urine) is rare in men who have cryotherapy as their first treatment for prostate cancer, but it is more common in men who have already had radiation therapy.
After cryotherapy, less than 1% of men develop a fistula (an abnormal connection) between the rectum and bladder. This rare but serious problem can allow urine to leak into the rectum and often requires surgery to repair.
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Chin JL, Al-Zahrani AA, Autran-Gomez AM, Williams AK, Bauman G. Extended followup oncologic outcome of randomized trial between cryoablation and external beam therapy for locally advanced prostate cancer (T2c-T3b). J Urol. 2012;188:1170-1175.
Moul JW. Rising serum PSA after radiation therapy for localized prostate cancer: Salvage local therapy. UpToDate website. https://www.uptodate.com/contents/rising-serum-psa-after-radiation-therapy-for-localized-prostate-cancer-salvage-local-therapy. Updated November 29, 2017. Accessed April 3, 2019.
National Cancer Institute. Physician Data Query (PDQ). Prostate Cancer Treatment – Health Professional Version. 2019. Accessed at https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. On April 3, 2019.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Prostate Cancer. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf on April 3, 2019.
Pisters LL and Spiess PE. Cryotherapy and other ablative techniques for the initial treatment of prostate cancer. UpToDate website. https://www.uptodate.com/contents/cryotherapy-and-other-ablative-techniques-for-the-initial-treatment-of-prostate-cancer. Updated September 13, 2018. Accessed April 3, 2019.
Zelefsky MJ, Morris MJ, and Eastham JA. Chapter 70: Cancer of the Prostate. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
Last Revised: August 1, 2019
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