Cryotherapy for Prostate Cancer: Cryoablation – Complete Guide

What is cryotherapy for prostate cancer?

Cryotherapy (also called cryoablation or cryosurgery) is a minimally invasive treatment that uses extreme cold to freeze and destroy prostate cancer cells. It is one of the oldest focal therapy modalities and has the longest follow-up data.

Cryotherapy can be used as primary treatment for localized prostate cancer or as salvage treatment for cancer that recurs after radiation therapy.

How does cryotherapy work?

Cryotherapy works by freezing prostate tissue to lethal temperatures:

• Thin needles (cryoprobes) are inserted through the perineum into the prostate under ultrasound guidance
• Argon gas circulates through the probes, freezing tissue to -40°C
• A warming catheter (urethral warmer) circulates warm saline to protect the urethra from freezing
• Thermocouples monitor temperature near the neurovascular bundles and rectum
• Two freeze-thaw cycles are performed (freeze, thaw, freeze again) – this enhances cell death
• The ice ball is visible on ultrasound, allowing real-time monitoring

Whole-gland vs. focal cryotherapy

Cryotherapy can be performed as whole-gland or focal treatment:

• Whole-gland cryotherapy: Entire prostate is frozen. Similar to radical prostatectomy or whole-gland radiation. Higher side effect rates (ED, incontinence). Used for intermediate or high-risk cancer.
• Focal cryotherapy (hemiablation): Only the cancerous part of the prostate is frozen (one lobe). Lower side effect rates. Used for unilateral, low to intermediate-risk cancer.

Who is a candidate for cryotherapy?

Primary cryotherapy (for untreated cancer):

• Low-risk or favorable intermediate-risk prostate cancer (Gleason 6 or 3+4=7)
• Unilateral disease (one side of the prostate) – for focal cryotherapy
• Prostate size <60 mL (preferred)
• No evidence of extracapsular extension or seminal vesicle invasion
• Patient preference to avoid surgery or radiation

Salvage cryotherapy (for cancer recurring after radiation):

• Biopsy-proven local recurrence after external beam radiation or brachytherapy
• No evidence of metastatic disease
• Life expectancy >10 years

The cryotherapy procedure – what to expect

Before the procedure:

• Stop blood thinners as directed (5-7 days before)
• Bowel preparation (enema)
• Antibiotics to prevent infection

Day of procedure:

• Anaesthesia: Spinal or general anaesthesia
• Duration: 1-2 hours
• Hospital stay: Outpatient or 23-hour stay

Step-by-step:

1. You are positioned on your back with legs elevated (lithotomy position)
2. An ultrasound probe is inserted into the rectum
3. A urethral warmer is placed to protect the urethra
4. Cryoprobes are inserted through the perineum into the prostate
5. Thermocouples are placed near the neurovascular bundles and rectum
6. Two freeze-thaw cycles are performed (10 minutes freeze, 5 minutes thaw)
7. The ice ball is monitored on ultrasound
8. Probes and urethral warmer are removed
9. A urinary catheter is placed (temporary)

Recovery and side effects – ED, incontinence, retention

Immediate side effects (first 1-2 weeks):

• Catheter: 7-10 days (whole-gland) or 3-7 days (focal)
• Hematuria (blood in urine): Common – resolves in days
• Dysuria (painful urination): Common – treat with urinary analgesics
• Urinary retention: 5-10% (catheter reinsertion may be needed)
• Swelling of the penis/scrotum: Temporary

Long-term side effects (whole-gland cryotherapy):

• Erectile dysfunction (ED): 40-80% at 2 years (higher than surgery/radiation)
• Urinary incontinence: 5-15% need pads at 12 months
• Urethral stricture: 2-5% (narrowing of the urethra)
• Rectal injury/fistula: <1% (rare)

Long-term side effects (focal cryotherapy):

• Erectile dysfunction: 10-20% at 2 years (much lower than whole-gland)
• Urinary incontinence: <5% need pads

Success rates – biochemical recurrence-free survival

Success rates vary by risk group and treatment extent:

Primary whole-gland cryotherapy:

• Low-risk (Gleason 6): 5-year biochemical recurrence-free survival: 80-90%
• Intermediate-risk (Gleason 7): 5-year biochemical recurrence-free survival: 70-80%
• High-risk (Gleason 8-10): 5-year biochemical recurrence-free survival: 50-70%

Primary focal cryotherapy:

• Low to intermediate-risk: 5-year biochemical recurrence-free survival: 70-85%
• Need for repeat treatment: 20-30% within 5 years

Salvage cryotherapy (after radiation failure):

• 5-year biochemical recurrence-free survival: 40-60%
• Higher complication rates (incontinence 10-20%, fistula 1-5%)

Salvage cryotherapy after radiation failure

Salvage cryotherapy is an option for men with biopsy-proven local recurrence after external beam radiation or brachytherapy.

Indications:

• PSA rise after radiation (nadir +2 ng/mL – Phoenix criteria)
• Biopsy-proven local recurrence
• No evidence of metastatic disease (negative PSMA PET/CT)
• Life expectancy >10 years

Outcomes:

• 5-year biochemical recurrence-free survival: 40-60%
• 5-year metastasis-free survival: 70-80%

Complications (higher than primary cryotherapy):

• Urinary incontinence: 10-20%
• Erectile dysfunction: 50-80%
• Rectourethral fistula: 1-5% (requires surgical repair)

Cryotherapy vs. surgery vs. radiation – comparison

Feature	Cryotherapy (Whole-Gland)	Surgery (Radical Prostatectomy)	Radiation (IMRT/SBRT)
Erectile dysfunction	40-80%	20-50%	20-40%
Urinary incontinence	5-15%	5-10%	<5%
Bowel side effects	<1%	<1%	10-20% (acute)
Dry ejaculation	100% (whole-gland)	100%	No
Hospital stay	Outpatient/23-hour	1-2 days	None
Recovery time	1-2 weeks	2-4 weeks如何看待None (during treatment)
Salvage option after failure	Yes (surgery/radiation)	Salvage radiation	Salvage cryotherapy or surgery

Interactive FAQ – Cryotherapy for prostate cancer

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Disclaimer: This information is for educational purposes. Cryotherapy is a treatment option for select prostate cancer patients. Discuss with a urologist at Vivekananda Hospital to determine if you are a candidate.