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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.
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
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.
| |
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:
- Moderate pelvic pain
- Blood in the urine
- Mild urinary urgency
- Scrotal swelling
These side-effects usually go away within a
few weeks. Most men recover their normal bowel and bladder
function.
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