How Can Cryotherapy Help In The Management Of Prostate Cancer?

Anyone – young or old can be detected with prostate cancer. Early screening is recommended and treatment options can be a tough decision. With increasing incidence rates among younger men, early detection and recourse are strongly advised. A common myth surrounding prostate cancer is that every form of it needs surgery or chemo. It is only one of the options from the several treatments available. Some tumors may be aggressive and others might progress slowly, that too, over the years. If the cancer has grown over several stages and has spread to many parts then there are options for immediate surgery and radiation. The risks can be determined basis family genes, age, ethnicity etc. Men with lower risk can also be monitored with Active Surveillance. This means getting frequent PSA level tests, biopsies, or DREs.

american urological association grants primary treatment status to cryotherapy Prostate Cancer

A person who is in the lower risk zone may only require Active Surveillance. Prostate Cancer is not self-treatable and with any visible symptoms, it is better to opt for screening immediately. Also, if diagnosed early where the cancer is only restricted to the prostate area; the chances of cure are higher. If the cancer has spread beyond the prostate then it may be difficult to cure. There are various options and prognosis available for treating Prostate Cancer. There are precision medicines like immunotherapy that can cure better than treating excessively that cause side effects. Consult a specialist for reliable information and support.

Partial gland ablation has emerged as an alternative front to treating cancer cells by targeting them like radical prostatectomy (surgical). One type of partial gland ablation is HIFU or high-intensity focused ultrasound that kills cancer cells with high-frequency sound waves. Another is cryoablation, which uses extremely cold conditions through a very thin needle to kill cancer cells.

There is various nomenclature awarded to the word cryotherapy – including cryosurgery or cryoablation. However, cryotherapy is not a type of surgery. The method involves using extremely cold temperatures to freeze cancer cells. Even with early intervention or treatment prostate cancer can come back in 30-40% of cases. Experts believe that cryotherapy may be more effective than radiation therapy that doesn’t kill enough cancer cells.

Cryotherapy may be treated as an option in certain cases where the cancer may be at a low risk or an early stage and where chemotherapy or surgery is not possible. It is however not a conventional form of medical treatment for prostate cancer. In cryotherapy, cancer cells are frozen, effectively cutting off their blood supply. Small needles are placed in the tumor where argon and helium gases are exchanged. With the freezing and warming cycle, the tissue that is frozen and dead is thawed by naturally getting absorbed by the body.

Different cryotherapy procedures?

Prostate cryotherapy can be useful in treating localized prostate cancer. Depending on the type of tumor and the appropriate treatment needed, your doctor will suggest the appropriate course. There are two types of procedures:

  1. Whole-prostate: This involves treating the entire prostate which may include both cancerous and non-cancerous, healthy tissues.
  2. Focal: As the name suggests it treats the part which is affected by cancer. This means that only the lesser healthy tissue is frozen. This may not be suitable for all men as it depends on the size of the cancer and where it is present in the prostate.
How does cryotherapy work?

Cryotherapy is minimally invasive with no incisions and uses extremely cold temperatures to kill the cancer cells. Focal prostate cryoablation is used to freeze only a part of the prostate and not the entire gland. This allows doctors to pinpoint and target areas while preserving regions where nerve cells are associated with potency. Tissues whether healthy or unhealthy cannot withstand extreme temperatures. It also helps control urinary incontinence.

Fusing gases like argon and nitrogen into the prostate withdraws heat from the gland. After the heat has been removed, ice crystals are formed which instantly swell up. This causes the cell membranes to rupture followed by tissue damage and death of the cells. The WBCs are responsible for taking care of the dead cancer cells/tissues.

Who can opt for cryotherapy?

It can be an effective treatment method for prostate cancer in the following situations:

  • Men detected in the early stages of cancer wherein the cancer hasn’t spread from the prostate to other parts
  • Those who are healthy without any complications or are not on any medication that conflicts with the procedure and are fit to undergo radiation or surgery
  • It can also help treat cases where radiation therapy has failed or has not been a complete success
  • Sometimes it can also be used in treating symptoms where the cancer has spread beyond the prostate gland and not necessarily just for treating cancer

  • Cryotherapy is not recommended for men with a large prostate gland

 

Preparation before getting cryotherapy?

Depending on your medical history, your doctor will review your health condition before the procedure. You may be asked to take a physical exam or blood tests to make sure the cancer is confined to the prostate. If you are sensitive or allergic to certain medications or procedures, your doctor will talk you through the whole process first. If you have a history of bleeding or if you take blood-thinning medicines, then you would be asked to stop them. Giving up smoking also helps the recovery process. You may also be asked to not eat or drink anything 8 hours before the cryosurgery.

Process of cryotherapy

The cryoablation system has needles and requires the management of the flow of Argon and Helium gases. Argon is used for the freezing process whereas Helium is used for the thawing process. The physician then controls how the ice balls are formed. The treatment can take 2-3 hours under anesthesia.

Firstly, the patient is injected with spinal/epidural anesthesia or general anesthesia. The other needles monitor the temperature in and around the prostate. Using transrectal ultrasound there are several hollow probes made between the anus and scrotum into the prostate through the perineum. Extremely cold gases are passed through the needles thereby carefully freezing and destroying the prostate gland. This is done without damaging surrounding tissues and by carefully observing the ultrasound during the procedure.

A warming tube is placed to prevent the urethra from getting damaged and a catheter is used for urine drainage (for almost 1 or 2 weeks after the procedure). At the same time, salt water is passed through a catheter in the urethra to keep it warm. The bladder slowly empties itself and the catheter may be left in there for several weeks. Meanwhile, the patient also recovers during this period. You can either choose to go home the same day or you may require overnight hospitalization. Consult your doctor for the best available recourse.

Once you have had cryotherapy for prostate cancer, there will be regular follow-ups. Periodic scans, testing etc. will need to be carried out to ensure the cancer has not progressed further.

Cryotherapy may be a more preferable method as it is less invasive than surgery. The science behind cryotherapy or its long-term effectiveness is less known than conventional methods.

It has been observed that some suffer more side effects than others especially if they have used radiation therapy before. Among men who have used cryotherapy as their first form of treatment, side effects are not so well-known. There are some immediate effects such as passing blood in urine, soreness, or even swelling of the penis/scrotum.

Risks of opting for cryotherapy

In cryotherapy – freezing of the prostate may affect the bladder or rectum. There may be pain, severe burning, frequent bowel movement, or frequent urination. In most cases, the bladder/bowel functionality can be gained over time. Erectile dysfunction is also a common problem as freezing of the gland, leads to nerve cell damage that controls erection. Some men may also develop a fistula which leads to urine leakage that passes into the rectum. This may require surgery as a corrective action. Sometimes an infection can develop or there may be swelling around the penis or scrotum. The soreness can also emanate from the regions where needles have been placed.

Sometimes there may be rarer side-effects such as rectum injury, blockage of the urethra that carries urine, or inflammation to the pubic bone. There may be many other risks that may be assessed better by your doctor depending on your health condition. Discuss any healthcare concerns with your physician for in-depth understanding.

There may be some pain or discomfort post cryotherapy. This may be observed for a couple of weeks or months and it may be in the areas surrounding the penis, testicles, or rectum. It can be relieved by using drugs or else the pain will subside eventually.

Effectiveness of cryotherapy

Cryotherapy Minimally invasive treatment for prostate cancer - medicametrix

There are many methods available for treating localized prostate cancer and they include – radiation therapy, brachytherapy, and radical prostatectomy. Sometimes surveillance and watchful waiting may be other ways to observe how the prostate cancer is progressing. In 1996, the American Urological Association has granted primary treatment status to cryosurgery in the United States as a therapeutic method for treating localized prostate cancer. Cryotherapy is an effective form of treatment and is minimally invasive. The surgical risks are lower with lower morbidity rates and higher chances of survival with longer follow-up rates. PSA tests are mandatory in observing post-treatment conditions. PSA levels increase rapidly following cryosurgery and come back to normal levels only over a period of time. Prostate biopsies are also conducted on the 6th, 18th, and 36th month and digital rectal examinations have to be taken to check the success of the procedure. Cryosurgery is considered a very good option for localized tumors, especially for low and immediate risk groups.

The FDA approved cryotherapy as an effective localized treatment against prostate cancer in 2000. Approval for the destruction of tissue including the prostate tissues has also been awarded by the FDA. Cryotherapy is a great option for treating earlier stages of cancer or treating resistant or recurring tumors. It may not be ideal for men with enlarged prostate glands where brachytherapy may be more suitable. This involves placing radioactive material inside the body and is also known as internal radiation. In turn, it causes the tumor to shrink and can effectively kill cancer cells.

The controversy surrounding cryotherapy now stands resolved with technological advancements. Back in 1968, when it was introduced, the cryoablation procedure took place with probes and cooled nitrogen. This brought up several complications and with the introduction of transrectal ultrasound (TRUS) and warming tube, several impressive results have been achieved. There has also been significant development where ultra-thin 17-gauge needles are now available to medical practitioners. This has enabled utmost precision and care in handling the procedure.

There are several medical groups that have been working towards establishing a uniform way of performing cryoablation. They are also looking into monitoring the long-term effects and benefits of this therapeutic method. Cryotherapy is also beneficial to those where hormonal therapy has failed and the cancer is still in its localized stage. It can also be used as a salvage therapy where any kind of radiotherapy has failed or has caused side effects. However, if a patient has rectal bleeding, fistulas then a gap of up to 2 years may be recommended to observe the side-effects of radiation surgery. There may be special cases where cryotherapy can be recommended as the primary treatment method. This requires additional precautions and complete knowledge of the patient’s medical history.