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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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