How effective is cryotherapy in the treatment of prostate cancer?

Dr. Marc B. Garnick, MD
Hematologist & Oncologist

Results of cryotherapy for prostate cancer have varied depending on the type of equipment used and the definition of biochemical progression, making it difficult to draw direct comparisons between groups of patients. However, even among patients at high risk of disease progression, most of those who undergo cryotherapy with argon and ultra-thin needles can continue to experience biochemical recurrence during the next several years. There can be significant side effects with cryotherapy and its popularity is quite limited. It may be used to treat prostate cancer initially treated with radiation and the cancer has recurred at some later point. 

Older patients with prostate cancer, and those with multiple medical conditions that might be aggravated by surgery or radiation, find cryotherapy an attractive option. Others who might want to consider cryotherapy include patients who:

  • have cancer that may have spread locally, increasing the likelihood of positive margins with a radical prostatectomy (cryotherapy can freeze cancers that have escaped from the prostate)
  • have a moderate to high risk of recurrence even after surgery or radiation therapy (unlike other procedures, cryotherapy can be repeated)
  • opt for hormone therapy and later find out that their prostate-specific antigen (PSA) is rising again
  • do not want radical surgery or other procedures

Most complications from cryotherapy for prostate cancer, such as incontinence, urinary obstruction and the development of a fistula (a hole in the rectum), have decreased dramatically thanks to modern technology and the evolution of techniques to keep the urethra and rectum warm. (A rectal fistula is now quite rare.) But nearly all patients who are potent before treatment are impotent afterward because there's no way to avoid freezing some nerves.

I do not recommend cryotherapy for my patients.

Cryosurgery essentially freezes the prostate gland thereby destroying the tumor, and it is less invasive than other forms of treatment. But while minimally invasive is a great way to go (that’s one of the reasons I advocate robotic prostatectomy), cryotherapy may not be invasive enough. Although cryosurgery is technically an option for some patients, it has major drawbacks for the following reasons:  

  • Prostate gland volume is a factor; the larger the prostate, the more difficult to achieve a uniformly cold temperature throughout the gland which could lead to cancer recurrence.
  • During total gland cryosurgery, the ice ball extends outside the prostate capsule and in most cases encompasses both sets of nerves that are responsible for erections, commonly resulting in erectile dysfunction.

The incidence of erectile dysfunction among cryotherapy patients ranges from 49 to 93 percent at one year.

Today’s elderly population wants to live longer and maintain a high quality of life throughout. For this reason cryotherapy is more often considered in men who are not concerned with erectile function or who cannot undergo radiation due to inflammatory bowel disease, or rectal disorders.

Cryotherapy or cryosurgery involves inserting a small metal tool into the tumor and destroying the cancer cells by freezing them. Over the years, the technique has been improved to limit the amount of healthy cells in the surrounding area that are affected, but data on long-term outcomes is still unknown. Side effects include sexual and urinary side effects.

Despite the best efforts of both radiation oncologists and urologic surgeons, sometimes prostate cancer recurs. For those rare cases, cryoablation of the prostate gland may be used. 

During cryotherapy treatment, the surgeon uses ultrasound to guide the placement of thin needles into the area being treated. Argon gas is used to form ice at the end of the needles. Cancer cells are more sensitive to cold than regular cells, so the freezing destroys the cancer cells.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.