Some prostate cancer patients good candidates for cryoablation

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Dear Doctors: Why don’t we hear more about cryoablation as a treatment for prostate cancer? It appears to be much easier than major surgery, so it seems like it would be a good option. What does the procedure entail? I am also interested in knowing about the advantages and disadvantages.

Dear Reader: Prostate cancer is the second-most-common type of cancer in men. Only skin cancers occur more often. This type of cancer arises in the prostate gland, which is about the size and shape of a walnut and is located beneath the bladder.

Because the prostate sits amid a complex network of nerves and structures that contribute to both sexual and urinary function, removing tumors in this type of cancer can be challenging. Depending on size and specific location of the cancer and whether it has spread, prostate cancer treatment can result in urinary incontinence and loss of sexual function.

Therapies may consist of one or more approaches, including surgery, radiation, chemotherapy, hormone therapy or immunotherapy. Cryoablation, also known as cryotherapy, can also be an option in certain cases. This is a procedure in which abnormal tissues are subjected to extremely cold temperatures, which destroys the cells.

Cryotherapy is performed under either regional or general anesthesia. It may be an outpatient procedure, or it can sometimes require an overnight hospital stay. Guided by ultrasound imagery, the physician inserts thin, hollow needles, known as cryoprobes, into a specific region of the prostate gland. The cryoprobes infuse freezing gas into the cells of the prostate gland, which kills them.

There are two forms of cryotherapy for prostate cancer. One type, known as whole-prostate cryotherapy, treats the entire gland. This kills both the cancer cells and the healthy tissues. Freezing the tissues of the prostate gland often damages the nearby nerves that control erections. As a result, erectile dysfunction occurs more often after whole-prostate cryotherapy than when the gland is surgically removed.

The other type of cryotherapy, known as focal cryotherapy, targets only the cancer cells. This allows less of the healthy tissue in the prostate to be destroyed. With focal cryotherapy, the risk of the loss of sexual function is minimized, but not eliminated. This approach is typically reserved for cancers that are small, well-defined and have not spread.

In both types of cryotherapy, a catheter filled with warm saltwater is used to protect the urethra. This is the tube that empties the bladder. The catheter is left in place for several weeks after the surgery, which ensures that the patient can empty his bladder as he recovers.

Elizabeth Ko, MD and Eve Glazier, MD

You are correct that cryotherapy is less invasive than surgery. It is also less painful and has a faster recovery period. However, it is not suitable for all patients. Factors such as the size, location and typing of the patient’s cancer, as well as the size of their prostate, play a role in whether cryotherapy can be an option. It is also unclear at this time if the long-term survival rates of this approach match those of either radiation or surgery.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)