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Cryotherapy

The information on this page comes from our Tool Kit fact sheet on active surveillance. To order your own tailored copy of the Tool Kit, visit our publications page. You can also download and print a PDF version of this fact sheet.

This page is for men who are thinking about having cryotherapy (also known as cryosurgery) to treat their prostate cancer. This page describes how cryotherapy treats prostate cancer and what the side effects may be. Each specialist team will do things slightly differently so use this page as a general guide to what to expect and ask your specialist team for more details about the treatment you will have. You may also wish to call our confidential Helpline on 0800 074 8383 for more information about treatment for prostate cancer.

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Who can have cryotherapy?

Currently, cryotherapy is available as a treatment for prostate cancer that has come back after treatment with radiotherapy or brachytherapy.

You may also be offered cryotherapy as a first treatment if your cancer has not spread outside the prostate gland (localised disease). Research shows that cryotherapy is safe and effective for treating localised prostate cancer 1. However, we need more research to show whether cryotherapy improves quality of life or long term survival, compared to other treatments2.

Your specialist team can give you more information about your treatment options. If you are thinking of having cryotherapy, you may wish to ask your consultant about their success rates for men with your stage of prostate cancer before deciding on your treatment.

Other treatment options for localised prostate cancer may include:

Another option for treating localised prostate cancer is HIFU (High Intensity Focused Ultrasound). This is a fairly new treatment in the UK and we do not know very much about its long term effectiveness. HIFU may be available as a first treatment for localised prostate cancer as part of a clinical trial or through private healthcare 2.

Men with severe urinary symptoms may not be suitable for cryotherapy. If you have difficulty passing urine or have to pass urine frequently you may wish to discuss this with your specialist team.

Some men may need to take hormone treatment for a few months before having cryotherapy to reduce the size of the prostate gland. Cryotherapy is not recommended for men with very large prostate glands because the area that can be frozen is limited to a certain size and it can be more difficult to place the needles. Your specialist team will discuss this with you. Hormone therapy can cause side effects, but these should stop a few months after you finish the hormone treatment.

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How does cryotherapy treat prostate cancer?

A number of probes, called cryoneedles, are inserted into the prostate gland under anaesthetic. The probes freeze the prostate gland, killing both normal and cancer cells within the gland. Many of the side effects of the treatment are caused when normal cells are frozen and damaged. The treatment involves getting the right balance between freezing the whole prostate gland to kill all the cancer cells and protecting parts of the gland to avoid damaging healthy cells.

The cryotherapy equipment has improved in recent years to allow more accurate control over the areas to be treated. This has reduced the risk of side effects and improved the success of the treatment 3. Your specialist team can give you more information about the risk of side effects.

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What are the advantages and disadvantages?

Advantages

  • Minimally invasive surgery with little blood loss
  • Short hospital stay and recovery time
  • As long as you have not had other prostate cancer treatment before having cryotherapy, you can still have radiotherapy or surgery if the cancer starts to grow again after treatment

Disadvantages

  • High risk of erectile dysfunction
  • There is little research data on long term survival after cryotherapy
  • Available in relatively few centres in the UK, compared with other treatments

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What does treatment involve?

Cryotherapy usually involves a one or two day stay in hospital. You will have a laxative drink before the procedure to ensure your back passage (rectum) is empty. This helps to get good pictures of the prostate gland with the ultrasound probe. Your specialist team will tell you how and when to take the laxative.

The cryotherapy procedure is carried out under either general or spinal anaesthetic. A tube (catheter) will be passed through your penis into your bladder to drain urine while you are under the anaesthetic. Your surgeon may also pass a second catheter through the wall of your abdomen into the bladder.

Several (six or more) cryoneedles are inserted into the prostate gland using an ultrasound probe in the back passage to guide them into position. Temperature-monitoring probes are inserted in and around the prostate gland. Warm saline is circulated through the catheter in your penis to protect the healthy tissue of the tube that you pass urine through (urethra).

Freezing gases are passed down the cryoneedles causing the temperature to drop to about - 40oC. The prostate gland is then allowed to return to room temperature. This is called a freeze-thaw cycle. The process of freezing and thawing is repeated.

The cryoneedles are then removed, along with the temperature monitoring probes. If you have two catheters, one of them will be removed. You may be given a dressing on the area between your testicles and back passage (perineum) to apply pressure and reduce any bruising and swelling.

The whole process usually takes around two hours. You will be given antibiotics to reduce the risk of infection, which you will need to continue taking for a few days after you go home.

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What happens afterwards?

You will usually go home the day after the procedure with a catheter in place. Your specialist team will show you how to care for the catheter before you leave the hospital. Around one to two weeks after the procedure you will have an appointment to have the catheter removed at the hospital; this may be uncomfortable but is not painful. You will need to stay for a few hours after the catheter has come out to check you can pass urine without difficulty. You may wish to take some spare underwear with you.

It is normal to have some discomfort after the treatment. Your specialist team will advise you on which painkillers you can take.

Bruising and swelling of the scrotum, buttocks and inner thigh are common in the few weeks after the procedure. Avoid long periods of standing for the first few weeks. You will be able to go back to your normal day to day activities as soon as you feel able to.

You may see some blood in your urine, both while the catheter is in and after it has come out. This is normal, however if you are worried you should contact your specialist team for advice.

You will be followed up by your specialist team in the hospital to check your recovery and to monitor your response to the treatment. Your Prostate Specific Antigen (PSA) will continue to be monitored to measure how well the treatment has worked. Your PSA may be checked at six weeks, three months, six months, nine months and then yearly. However, this will depend on your individual PSA test results and may change as we learn more about the long term effects of cryotherapy.

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What are the side effects?

As with all treatments, side effects vary from man to man and it is not possible to predict who will get them. Side effects are usually more common in men who have had previous treatment for prostate cancer 3.

Short term side effects

  • Blood in the urine
  • Bruising and swelling of the penis, scrotum, inner thigh and the area between your testicles and back passage (perineum)
  • Pain and/or bleeding where the needles have been inserted

You should be given antibiotics to prevent infection after the procedure. Contact your specialist team if your urine becomes strong smelling or if you have a temperature, as you may need more antibiotics.

Mid to long term side effects

Erectile dysfunction

The most common long term side effect is problems with erections or ejaculation. More than half of men (53 to 95 per cent) will be unable to get or maintain an erection following cryotherapy 3. Some men find that they cannot ejaculate or that semen does not come out until they next pass urine (retrograde ejaculation).

Sexual function can continue to improve for several years after cryotherapy. Up to half of men (five to 47 per cent) may be able to get an erection with or without medical assistance 4.

Urinary symptoms

Cryotherapy can cause a variety of urinary problems. A small number of men (up to one out of every six men 4) will leak urine following treatment. This may or may not improve with time and you may have to use pads in your underwear either temporarily or permanently.

Up to one in ten men (up to 10%) will be unable to pass urine at all and will need to have a catheter inserted to drain the urine temporarily. Others will have trouble passing urine, because of a slow flow or needing to pass urine frequently. Some men will have some discomfort on passing urine which may take some weeks or months to stop.

There is a risk of narrowing (stricture) of the tube that carries urine out through the penis (urethra). In severe cases this may need an operation to relieve the blockage.

Rectal problems

Some men have reported pain in the back passage (rectum) following cryotherapy.

A rare complication is a hole forming between the back passage (rectum) and the tube which carries urine through the penis (urethra). This is known as a fistula and it affects between one and two out of every 100 men (one to two per cent)4. If this happens, you will need an operation to repair the hole.

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Questions to ask your specialist team

  • How successful is cryotherapy at treating prostate cancer?
  • Will I need to take hormone treatment before having cryotherapy?
  • How long does the operation take?
  • How often will you check my PSA after the treatment?
  • What is the risk of side effects?

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Links

The following organisations provide further information relevant to this page.

Cancerbackup
www.cancerbackup.org.uk
For information on coping with cancer and treatment.

Dipex
www.dipex.org.uk
Watch, listen to, or read personal experiences of cancer diagnosis and treatment. Includes interviews with men who have had cryotherapy to treat prostate cancer.

Macmillan Cancer Support
www.macmillan.org.uk
Practical, emotional and financial support for people with cancer, family and friends.

National Institute for Health & Clinical Excellence (NICE)
www.nice.org.uk
NICE produce two booklets on cryotherapy. To order a copy, call 0870 1555 455 and quote ref. N0940 for information on cryotherapy as a first treatment and quote ref. N0837 for information on cryotherapy for recurrent prostate cancer.

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Reviewed by:

  • Frank Chinegwundoh, Consultant Urological Surgeon, Barts and the London NHS Trust and Newham University Hospital NHS Trust
  • Professor Damien Greene, Consultant Urologist, City Hospital, Sunderland
  • Bronia Thomas, Macmillan Urology Nurse Specialist, Sunderland Royal Hospital
  • The Prostate Cancer Charity Information Volunteers
  • The Prostate Cancer Charity Support & Information Specialist Nurses

Written by:

Karen Thomas, Urology Nurse Specialist

Edited by:

The Prostate Cancer Charity Information Team

References used in the production of this page.

1 Cohen JK, Miller RJ, Ahmed S et al. Ten-Year Biochemical Disease Control for Patients with Prostate Cancer Treated with Cryosurgery as Primary Therapy. Urology 2008; 71: 515–518.
2 National Institute for Clinical Excellence. Prostate cancer: diagnosis and treatment. Full Guideline 2008
3 Gowardhan B. Thomas B. Asterling S. Sheikh N. Greene D. Cryosurgery for prostate cancer-experience with third generation cryosurgery and novel developments in the field. 2007 European Urology Supplements 6 (8) 516-520.
4 Shelley M, Wilt TJ, Coles B, Mason MD. Cryotherapy for localised prostate cancer. Cochrane Database of Systematic Reviews 2007, Issue 3.

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