Cryosurgery Surgery * Prostate Cancer * Kidney Cancer
The North Texas Center for Cryotherapy
Prostate cancer is the second most common cancer and the second leading cause of death in American men. The American Cancer Society estimates that 230,000 cases of prostate cancer are diagnosed each year and more than 28,000 men die from the disease.
What is Cryotherapy?
Cryotherapy is a treatment for prostate cancer and is an effective yet minimally invasive alternative to surgery and radiation therapy. The treatment utilizes slender probes called 'cryoprobes' that deliver cycles of extremely cold temperatures and warm temperatures to freeze, thaw, and ultimately destroy cancerous cells in and around the prostate gland. Under ultrasound guidance, the probes are inserted through the skin and are strategically placed in and around the prostate to target the entire gland and minimize damage to surrounding healthy structures. After two or more freeze/thaw cycles, the cancer cells die and the dead tissue is re-absorbed or remains in the body as scar tissue posing no further health threat.
The procedure is performed with the patient under either general or epidural anesthesia. Since it is minimally invasive and of a relatively short duration (1 -1.5 hours), it offers a quicker recovery and reduced severity of potential side effects, such as incontinence or impotence.
Targeted Cryoablation of the Prostate (TCAP)
Recent technological advancements have introduced a safer and more effective cryosurgical procedure called Targeted Cryoablation of the Prostate (TCAP). TCAP uses between six and eight ultrasound-guided cryoprobes to deliver a lethally cold temperature to specific areas in the prostate. The resulting ice ball that forms ensures that all cancer cells are immediately destroyed. It also uses thermosensors that enable surgeons to monitor the process and determine when the exact target temperatures have been reached. The treatment is highly effective for low, moderate and high risk localized prostate cancers; freezing kills cancer cells on contact regardless of how aggressive they are.
The most frequent complication associated with cryosurgery is sexual dysfunction, which occurs when the "erection" nerve bundles are damaged during the freeze/thaw cycle discussed earlier. "Fortunately, those nerve bundles can regenerate and sexual function can return in 18% of men in one year and in 40% of men in two years," explains Dr. Ellis. With nerve warming, the rates of successful erectile function are even higher - between 46% and 74%. During the nerve warming procedure, the nerve bundles are identified with a Doppler device; then a probe placed between the bundles is warmed during the freeze cycle to prevent or limit nerve damage.
What to expect with the Prostate Cryosurgery Procedure
- 1.5-2 hours under spinal or general anesthesia
- Discharged later that day or the next day
- Icepacks to scrotum and perineum for 3-5 days
- Suprapubic or Foley catheter for 1 week
- Anti-inflammatory medications for several days
- Can start golfing at 10-14 days
Early Side effects of Prostate Cryosurgery
- Swelling around scrotum and perineum for up to two weeks
- Urinary retention
- Uncomfortable to sit down (< 2 wks)
- Late side effects of cryosurgery
- Impotence 82-100 % initially, 47% have recovery after 3 years
- Urethro-rectal fistula (0-0.25%)
- Incontinence (1-4%)
- TURP needed (1-5.5%)
Prostate Cryosurgery Advantages
- Minimally invasive, minimal pain
- Hospitalization less than 24 hrs, brief recovery
- Favorable success & complication rate
- Very effective in patients at risk for positive margins
- Can be repeated
- Radiation or surgery is still an option for failures
- Excellent option for patients after failing radiation or brachytherapy
Prostate Cryosurgery Disadvantages
- Early Impotency (potentially permanent)
- Prostate should be < 45 gms
- Most larger glands can be downsized with several months of hormone therapy
- Catheter or suprapubic tube for 1 week
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