Prostate cancer, just like any cancer, is a dreaded diagnosis associated with fear, unpredictability, and uncertainty.
Most men with prostate cancer are given the choice of removing the prostate, which is done with an open incision or with robotic technology. The other more standard therapy is radiation treatments. However, some men with minimal disease elect close observation and watchful waiting.
Radiation can be delivered directly to the prostate in three ways: external beam therapy, seed implantation, or high-dose radiation therapy (HDR). However, there is a maximum amount of radiation that can be used to treat a specific area of the body, and once radiation is completed, it cannot be repeated.
Cryo-surgical ablation of the prostate is another way to treat prostate cancer, which requires the patient to be under anesthesia for approximately 90 minutes. The gland is frozen to approximately -20°C. Postoperatively the patient wears a catheter for approximately five to seven days. The procedure is performed without an incision by inserting cryo needles into the gland under ultrasound guidance and watching the prostate freeze live with ultrasound visualization.
Freezing the prostate gland destroys the cancer and the surrounding gland, and we use a urethral warmer to protect the urethra from the extreme cold. The destroyed tissue gets resorbed, and the patient usually has no pain or discomfort postoperatively except wearing a catheter.
So, who is a good candidate for cryo-surgical ablation of the prostate? My answer is those who have failed radiation therapy and who have local recurrence.
Patients with a small amount of disease localized to an area can have focal cryo-surgical ablation, which we do not do on a regular basis. Some patients who do not want to proceed with radiation therapy, who are elderly with low volume disease may also choose cryosurgery.
Cryo-surgical ablation of the prostate is usually not offered to the young and healthy men with prostate cancer who are sexually active, because when the entire gland is frozen, it will usually lead to erectile dysfunction.
Most patients who elect to have cryosurgery are generally older, and many have already been treated with radiation therapy and suffer from erectile dysfunction.
Another side effect that can occur with cryo-surgery or any other surgical procedure to the prostate is urinary incontinence. This is rare after cryosurgery, especially if the patient has not been pretreated with radiation before the freezing. If patients have had previous radiation, urinary leakage is a little more common and occurs approximately 8 to 10 percent of the time, and is usually quite manageable.
Injury to the surrounding structures such as the rectum is quite rare as we monitor the temperatures around the prostate to prevent surrounding tissue damage.
In conclusion, cryo-surgical ablation of the prostate is usually a well-tolerated outpatient procedure that can destroy prostate cancer and lead to long-term survival. The procedure can be redone in the future if needed.