Cryotherapy and Prostate Cancer

About Cryotherapy

Prostate cryotherapy is a surgical technique that can be used to treat localised prostate cancer. Cryotherapy uses extremely cold temperatures to freeze and destroy the prostate cancer cells. It is also referred to as cryosurgery or cryoablation, but essentially these all have the same meaning.

There are two types of cryotherapy either whole-prostate or focal cryotherapy. The surgeon will discuss the type of tumour you have and which treatment is most appropriate for you. Focal cryotherapy will not be suitable for all men and will depend on the size of cancer, and where it is in your prostate.

Surgeons can target and treat small amounts of tissue, minimising damage to nerves around the prostate responsible for preserving urinary continence and sexual function.

Prost8 UK have chosen the BTG Galil Cryotherapy system to deploy as part of our campaign.

How Cryotherapy works

The ICEfx Cryoblation System is a medical device designed for precise ablation of prostate tissue by highly targeted freezing of cancerous cells

What is Cryotherapy

Focal prostate cryoablation only freezes a portion of the prostate as opposed to the entire gland. Focusing on the specific areas where the surgeon believes the cancer resides allows them to preserve other regions of the prostate – in particular the nerves associated with potency (the ability to obtain and maintain an erection suitable for sexual intercourse) and the urinary sphincter which controls continence.

Focal prostate cryoablation is a relatively new technique but initial evidence supports that most men receiving the treatment remain potent and only a very small percentage become incontinent

In patients with low- and intermediate-risk diseases, the application of focal therapy shows promise in bridging the gap between active surveillance (AS) and more aggressive therapies.

How does it work?

A cryoablation system and cryoablation needles are key components to perform cryoablation. The cryoablation system manages the flow of pressurised gas (argon for freezing, helium for thawing) and provides the physician direct control of iceball development during a procedure.

What to expect

If you choose Cryotherapy you will receive pre-operative instructions from a consultant and nurse.

The cryotherapy treatment takes approximately two hours under general anaesthetic.

During cryotherapy, needles or probes are passed through the skin into the prostate. The surgeon uses ultrasound images of the prostate to ensure that the needles are put in the right place. Argon gas is then circulated through the needles, which makes them very cold. The result is that the surrounding prostate tissue freezes and is destroyed. The temperature in and around the prostate is monitored by other needles, which are also inserted at the start of the procedure.

During the treatment, a narrow ‘warming’ tube is in place in the urethra to prevent it from being damaged by the freezing process. A catheter (a narrow, flexible hollow tube inserted through the penis into the bladder) for urine drainage is left in place for one to two weeks after the procedure. Sometimes we need to use a suprapubic catheter – a catheter that is inserted through the skin of your lower abdomen (tummy) directly into the bladder.

After the treatment, patients will be in recovery for about 2-4 hours. Once released from the treatment centre, patients return home to recover more comfortably.

Cryotherapy Equipment

Prost8 UK have chosen to donate the most advanced Cryotherapy treatment equipment as part of our campaign. For that reason, we have been guided by top specialists to select the Boston Scientific (formerley BTG Galil) ICEfx system, or equipment to similar standard.

Boston Scientific recently acquired BTG Galil who are respected in the medical world as manufacturers of state-of-the art, minimally-invasive medical equipment that destroys tissue in the prostate using focused freezing techniques.

The ICEfx Cryoablation System offers predictable, reliable performance with seamless therapy delivery and exceptional ease of technical operation. The system is designed for interventional radiologists who want to offer their patients on-demand access to state of the art ablation technology.

How Cryotherapy treats the prostate

Cryotherapy, also known as Cryosurgery, Cryo, and Cryoablation, is a minimally invasive treatment (no incisions) that uses extremely cold temperatures to kill cancer tumours. Cryotherapy is widely used around the world and has over fifteen years’ reported clinical experience to support its safety and effectiveness.

Focal prostate cryoablation only freezes a portion of the prostate as opposed to the entire gland. Focusing on the specific areas where the physician believes the cancer resides allows doctors to preserve other regions of the prostate – in particular the nerves associated with potency (the ability to obtain and maintain an erection suitable for sexual intercourse) and the urinary sphincter which controls continence.

Focal prostate cryoablation is a relatively new technique but initial evidence supports that most men receiving the treatment remain potent and only a very small percentage become incontinent (lose the ability to control their urine flow). It is important that patients understand that focal prostate cryoablation may only be a temporary solution. Because focal prostate cryoablation focuses on a specific area of the prostate, at least half of the gland will go untreated. This may mean that small, developing tumours are not destroyed.

All patients undergoing focal prostate cryoablation should have very regular follow-up care to carefully monitor any changes. Focal prostate cryoablation does not exclude any treatment options for the future – including a repeat focal prostate cryoablation or primary prostate cryoablation.

Why choose Cryotherapy

Cryotherapy, or cryoablation, is a non-invasive, outpatient treatment option that allows men to return to their normal lifestyle in days, preserving patient quality of life.

Focal Cryotherapy is a suitable alternative treatment option to radical whole-gland surgery or radiotherapy in men wishing to preserve sexual function and normal urinary function.
HIFU patient benfits

Who can have Cryotherapy?

Focal therapy, including cryotherapy and focal ultrasound (HIFU), is usually best suited to men with early stage non-metastatic prostate cancer (although it can also be used in cases of recurrent disease). It will provide literally thousands of men with the opportunity to receive less invasive treatment and retain maximum functionality (urinary continence and erectile function) ongoing.

The advantages of focal therapy treatment for prostate cancer are superior to most current alternatives as it is usually a day stay procedure (you will go home the same day) with a short recovery time of one to two weeks.

Cryotherapy is minimally invasive with just thin needles inserted into the prostate gland from beneath the scrotum and a needle in your hand for general anaesthetic. It does not exclude other treatments, if required later, such as radiotherapy or surgery.

Unfortunately, cryotherapy for prostate cancer treatment is available in very few NHS hospitals right now but you can talk to your GP, consultant or nurse to see if it is available in your area.

Making focal therapy available to men across the UK is the main driving force of Prost8 as a charity and our aim is to raise funds and campaign to deploy at least one unit in each of the 22 UK NHS Cancer Care Alliances.

Our ambition is high as equipping each unit with both a HIFU system and a cryotherapy system costs in the region of £350,000 but, if successful, our plan will achieve this within the next two years.

However, it is less likely that focal therapy will be offered as an alternative if the cancer has spread outside of the prostate to other parts of the body (advanced prostate cancer) although it can be used in cases where the cancer has reoccurred after other treatments (recurrent prostate cancer) such as radiotherapy and is offered in these cases (salvage cryotherapy or HIFU).

Side effects

Patients can experience difficulty in passing urine after the treatment so a tube (catheter) is inserted at the time of the procedure to help with this and is usually left in place for one or two weeks. Some men may notice swelling of their penis or scrotum or pain in or around the rectum (back passage). This usually resolves within two to four months.

A small percentage may experience impotence / erectile dysfunction (problems getting or maintaining an erection). The nerves involved in creating an erection lie just behind the prostate gland. Whether they are affected during the freezing process will depend on which part of the prostate is treated.

Some patients experience leakage of urine but this should lessen or resolve over time. Some men may need to wear pads to protect their underwear. Tissue fragments in the urethra can occur in up to 5 in every 100 men. This may lead to pain or difficulty in passing urine. Occasionally an operation is needed to remove the tissue fragments.

More information about HIFU treatment

What does Cryotherapy involve?

Focal treatment is usually given which treats a smaller finely targeted area of the prostate, but sometimes whole-gland cryotherapy will be used to treat the entire prostate. Your consultant will advise which type is best suited to your condition.

Before treatment

If you have a large prostate you may be offered other treatments before you have cryotherapy. Sometimes your doctor will prescribe hormone therapy for several months to shrink the prostate and make treatment easier. Hormone therapy does come with side effects which will be explained at the time.

If you’re having focal cryotherapy you will usually go to a screening appointment first. You’ll have a magnetic resonance imaging (MRI) scan, which produces detailed images of the prostate and shows the location of the cancer. You may also have a prostate biopsy, which shows the location of the cancer and how likely the cancer is to grow and spread outside the prostate. These tests will help your surgeon target the area of the prostate that needs to be treated.

The day of treatment

You will be checked by a nurse upon arrival and given an enema to empty your bowels. This is a liquid that is put inside your back passage (rectum). You will have been advised not to eat or drink for several hours ahead of arrival.

Once ready to go to theatre you will be given a general anaesthetic (or an epidural if recommended by your doctor for health reasons). A catheter will usually be fitted ahead of treatment to control urine flow.

The cryotherapy treatment is delivered via thin needles that are inserted into the prostate gland from beneath the scrotum. The needles produce small finely targeted ice balls to freeze the cancerous cells preserving surrounding healthy tissue. A warming tube is usually insetted into the urethra via the penis during the procedure to prevent freezing damage to sections close to the ablation zone.

An ultrasound probe is also inserted into the back passage to create images of the prostate while your surgeon is treating it. This helps the surgeon target the cancer so that less of the healthy tissue is damaged.

Following treatment

Cryotherapy causes the prostate to swell initially which can make it difficult to urinate so a catheter will be fitted for the first week or so to drain urine until things settle down.

You may have pain in the peritoneal and rectal area after HIFU and you will receive pain-relieving drugs for this along with precautionary antibiotics to prevent possible infection. You may also be given a laxative to aid bowel movement.

Side effects

Focal therapy can cause short or longer-term side effects although these are rare and may include the following:

Urinary side effects

Some men may experience some urine leakage particularly after exercise or coughing. Some will experience issues with frequency of urination or starting and stopping but most of these symptoms settle down after a few weeks.