Cryosurgery

Your doctor may recommend cryosurgery for prostate cancer as an option at different times during your cancer treatment and for different reasons. Cryosurgery 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.

Cryosurgery for prostate cancer is done in the hospital. You may be given a general anesthetic, or your doctor may numb only the surgical area with a local or regional anesthetic.

Once the anesthetic takes effect, your doctor:

• Places an ultrasound probe in your rectum.
• Places a catheter inside the tube (urethra) that transports urine from your bladder out of your penis. The catheter is filled with a warming solution to keep the urethra from freezing during the procedure.
• Inserts several thin metal probes or needles through the area between the scrotum and the anus (perineum) into the prostate.
• Watches the images generated by the ultrasound probe to ensure correct placement of the needles.
• Releases argon gas to circulate through the probes or needles, cooling them and freezing nearby prostate tissue.
• Monitors and controls the temperature of the needles and the amount of freezing within the prostate gland.
• May place a catheter into your bladder through your lower abdomen to assist in draining urine after cryosurgery.

Side effects from cryosurgery 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 cryosurgery than after radical prostatectomy (removal of the prostate).

Urinary incontinence (having problems controlling urine) is rare in men who have cryosurgery as their first treatment for prostate cancer, but it is more common in men who have already had radiation therapy.

After cryosurgery, 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.

You’ll likely be able to go home the day of your procedure, or you may spend the night in the hospital. The catheter may need to remain in place for about two weeks to allow for healing. You might also be given an antibiotic to prevent infection. Cryosurgery is less invasive than a normal surgical procedure, so there is usually less blood loss, a shorter hospital stay, shorter recovery period, and less pain.

• Your doctor will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything isn’t clear.

• Your doctor will review your medical history and do a physical exam to be sure you are in good health before you have the procedure. You may also need blood tests and other tests to make sure the cancer is confined to the prostate.

• You will be asked to fast (not eat or drink anything) for 8 hours before the procedure, generally after midnight.

• Tell your doctor if you are sensitive to or allergic to any medicines, latex, iodine, tape, and anesthesia.

• Make sure your doctor has a list of all medicines and all herbs, vitamins, and supplements that you’re taking. This includes prescribed and over-the-counter medicines.

• Tell your doctor if you have a history of bleeding problems or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or any other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

• If you smoke, stop as soon as possible. This improves your recovery and your overall health status.

• You will be asked to take a laxative and/or enema to empty your colon the night before procedure. Make sure you understand these directions and have the supplies you need.

• You may be given a sedative before the procedure to help you relax.

Based on your condition, your doctor may request other specific preparation.