Freezing: Another Weapon for Prostate Cancer
Thomas J. Stormont, MD
Prostate cancer, when found early, can be treated by different methods. Currently more men are looking for less invasive treatment options, because of shortcomings and complications with the traditional therapies (surgery or radiation). Patients who choose freezing (also known as cryoablation or cryotherapy) are generally pleased because it was a minimally invasive, no incision treatment, with little bleeding or pain, and a brief <24 hour hospital stay. They also feel confident that they had a treatment with proven 10 year results, yet retained many options for treatment if the cancer recurs.
Cryoablation uses subzero temperatures to destroy abnormal tissue, which is then sloughed or resorbed by the body, while the surrounding normal tissue remains healthy. This technique has been modified over the past 50 years and now is now a Medicare approved minimally invasive treatment for prostate cancer, offering excellent preservation of quality of life and success similar to other treatments. Freezing of the prostate is a 1.5 hour procedure, done at the hospital with a spinal or general anesthetic. Six to eight slender probes are placed in the prostate through the perineum (the area between the anus and testes). Argon gas flows into the prostate, freezing it to approximately -40C. A warming catheter protects the urethra, and the surgeon monitors the process with temperature sensors and watching the freezing process on an ultrasound monitor. A temporary suprapubic or urethral foley is placed during the procedure. Afterwards, there is very little pain, and within a day most patients go home with the catheter. A normal lifestyle can usually be resumed within a week or two, after the catheter is removed. Your urologist will follow you periodically with PSA tests to monitor the success of the treatment.
The effectiveness of freezing localized prostate cancer, even those cancers that have failed radiation, appears equivalent or even superior to other forms of treatment with about 10 years of supporting data. In fact, freezing can even be repeated in some circumstances, if the cancer recurs. All prostate cancer treatments (surgery, radiation or freezing) can cause urinary (obstruction or leakage) and sexual side effects, and very rarely rectal injury. Freezing generally allows a quicker return to normal functioning and less chance of permanent urinary leakage (vs Radical Prostatectomy) with less risk of rectal problems (vs radiation) however, does result in ED in the majority.
There is a new method of freezing, called "focal cryoablation," that may be appropriate for a subset of men with a small amount of localized prostate cancer. This involves freezing only select parts of the prostate, and not the entire gland. Preliminary experience shows good cancer control rates with a significant reduction in reported ED.
The decision to choose freezing, or cryoablation, for prostate cancer needs to be carefully thought out, because every patient has his own unique set of circumstances. While not the ideal treatment for all men, it is another weapon that urologists and their patients have to fight prostate cancer.
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