Prostate cancer is a disease of the male reproductive system. It is the second most common type of cancer among men in the US. In 2015, there were about 220,800 new cases of the disease and 27,540 deaths from prostate cancer, according to the National Institutes of Health. An estimated one in every seven men will be diagnosed with the disease during their lifetime, but developing the disease is rare before the age of 40. The average age at the time of diagnosis is about 66, and the majority of patients are diagnosed after that age. In many cases, patients are only diagnosed during an autopsy after a death related to some other cause.
After the diagnosis and staging of the disease, physicians determine a choice of treatment based on patients’ age and expected lifespan, additional severe health conditions, patients’ and physicians’ options and opinions about each treatment option and its possible side effects, as well as probability of curing the cancer. Prostate cancer treatment options include expectant management (watchful waiting) or active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, vaccine treatment, bone-directed treatment, and cryotherapy.
Cryotherapy as a Treatment Option for Patients with Prostate Cancer
Cryotherapy, also known as cryosurgery or cryoablation, is a type of treatment used in many types of cancer and other diseases. In patients with prostate cancer, cryotherapy consists of freezing the cancerous cells in the prostate. “Most doctors do not use cryosurgery as the first treatment for prostate cancer, but it is sometimes an option if the cancer has come back after other treatments. As with brachytherapy, this may not be a good option for men with large prostate glands,” explain the American Cancer Society, adding that cryotherapy is less invasive than radical prostatectomy surgery and related to smaller loss of blood, shorter hospital stay, shorter recovery period, and less pain.
During the procedure, a transrectal ultrasound (TRUS) is used to guide several hollow probes (needles) through the skin between the anus and scrotum and into the prostate. Then, ice balls are created with very cold gases passed through the needles in order to destroy the prostate. “To be sure the prostate is destroyed without too much damage to nearby tissues, the doctor carefully watches the ultrasound images during the procedure.” The patient does not feel any pain since the lower half of the body is numbed with a spinal or epidural anesthesia, or the patient is put to sleep under general anesthesia. Physicians also place a catheter in the urethra during the procedure to circulate warm saltwater and prevent it from freezing.
Benefits and Risks of Cryotherapy in Prostate Cancer Patients
There isn’t much information about the long-term effectiveness of cryotherapy, but it is known to be less effective than radiation therapy. However, the cryotherapy is able to freeze and kill the cancer cells in the prostate. It is particularly indicated as primary treatment in cases of early-stage cancer confined to the prostate or as salvage therapy, after other cancer treatment to stop the growth of recurrent prostate cancer. The side effects of the treatment are usually worse in patients who previously underwent radiation therapy. Patients often experience soreness, swelling of the penis or scrotum and blood in urine right after the procedure.
“Freezing often damages the nerves near the prostate that control erections. Erectile dysfunction is more common after cryosurgery than after radical prostatectomy,” adverts the ACS. “Urinary incontinence (having problems controlling urine) is rare in men who have cryosurgery as their first treatment for prostate cancer, but it is more common in men who have already had radiation therapy. After cryosurgery, less than 1% of men develop a fistula (an abnormal connection) between the rectum and bladder. This rare but serious problem can allow urine to leak into the rectum and often requires surgery to repair.”
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