Prostate cancer is one of the most common forms of cancer in men. Some of its traditional treatments can result in serious complications. Cryoablation is an emerging alternative that shows great promise. What does this new treatment entail? What are its advantages and disadvantages? The following information should help answer those questions. What is cryoablation? Cryoablation is a form of cryotherapy for the prostate that involves the controlled freezing of the prostate gland in order to destroy cancerous cells. Who are the suitable candidates for cryoablation of the prostate? Suitable candidates for this procedure are patients who have organ-confined prostate cancer and have not had a prior transurethral resection of the prostate (TURP). How is the procedure performed? After induction of general anesthesia, the urologist guides an ultrasound probe into the rectum. Next, the urologist places the cryoablation probes into the prostate under continuous ultrasound monitoring. Using a flexible cystoscope, the urologist examines the bladder and urethra to confirm normal anatomy and inserts a suprapubic catheter (a small tube placed into the bladder through the lower abdomen). The urologist then introduces a specialized urethral warming catheter prior to starting the freezing process. This warming catheter helps prevent injury to the urethra while allowing lethal ice to kill the cancer cells within the prostate. Two freezing cycles are performed. What can be expected after treatment? Patients are usually discharged from the hospital the same day of surgery or very next morning. At the time of discharge, the suprapubic catheter drains the urine from the bladder. This diverts the urine away from the urethra, allowing it to recover from the procedure. Most patients are able to urinate in about 7 to 14 days, but some require longer recovery periods. The suprapubic catheter is removed when the patient is able to urinate well and empty the bladder satisfactorily. Other symptoms the patient may experience are urethral discharge, scrotal swelling and discoloration, numbness along the shaft of the penis, passage of flecks of tissue in the urine, pain or burning sensation during urination, and increased urinary frequency and/or urgency. If present, these symptoms usually resolve within a few weeks. Medications to minimize these minor side effects will be provided. A PSA test is done three months after the procedure. PSA measurements are then obtained every three to six months for the next several years. Our goal is to reduce the PSA value to < 0.5 ng/ml. What are the risks associated with this procedure? New technological advances have resulted in a significant reduction in the rate of complications. Improved urethral warming devices have minimized urethral complications. Better spacing of the probes now contributes to the effectiveness and safety of the procedure. Improved monitoring of the freeze cycle with continuous transrectal ultrasound and strategically placed temperature monitoring probes have dramatically reduced the number of complications. Some risks still exist. Perhaps one of the most critical is the development of a rectal-urethral fistula, an opening between the rectum and urethra. Fortunately, this complication is rare, well below 1 %. Other complications although uncommon given technological advances include urinary incontinence, urinary retention requiring a TURP, and inflammation of the scrotum. Permanent, severe incontinence is rare. Other rare complications include prostatic abscess and permanent penile numbness. An expected side effect of cryoablation of the prostate is erectile dysfunction. This side effect results from the planned formation of lethal ice in the tissue surrounding the prostate. This tissue sometimes contains microscopic foci of cancer cells. Unfortunately, since the nerves responsible for spontaneous erections reside in this periprostatatic tissue, the nerves, like the cancer cells, are exposed to thermal injury. New reports show up to 50% return of erectile function at 2-3 years in men fully potent before treatment. This may be due to slow but steady nerve regrowth after freeze injury. Also, focal cryo ablation with nerve sparing can be offered in selected cases for potent men wishing to preserve their potency. What are the advantages and disadvantages of cryoablation? Advantages:
Disadvantage:
Is cryoablation therapy ever used after other prostate cancer treatments have been tried? Yes. An important use of cryoablation therapy is for patients who develop a local recurrence after radiation therapy.
Eastern Shore Urology Associates, PA
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