ProstateCryotherapy:TheNo-scalpelIceTreatmentforCancer

Prostate Cancer Center

The physicians at the Urology Center are very aware of the special problems that many men experience, including prostate cancer, erectile dysfunction, overactive bladder problems, frequent urination, blood in the urine, prostate pain and others. Our urologists have specialized training and interest in the correction of these very treatable and often reversible problems. We have helped thousands of men overcome such problems and go forward with the confidence which comes from healthy living. This is an example comment that we have received concerning prostate cryoablation. Names have been changed for privacy reasons.

Everything is going well and I never had any pain(after prostate cryoablation). I did have a bruise but that is gone. The freeze treatment was easy and I didn't have any problems with the catheter. It was good not to have to stay in the hospital.

I would tell anybody with prostate cancer that this is the way to go... I would definitely do this treatment again(instead of surgery). Thank you for letting me know about the this treatment. I appreciate the work that you have done.

Mr. J. C.

Ponchatoula, Louisiana

This is but one example of many positive comments we have received. While we cannot expect to receive such enthusiastically positive comments from every patient, the vast majority of our patients are very happy with the personal attention and care they receive at the Urology Center. Additional patient references are available on request by contacting us at:

Nurse@theUrologyCenter.org

(985) 345-5500

(985) 626-9910

If after seeing our doctors, you would like to speak or meet with another patient who has had similar urology problems or surgery, the appropriate arrangements will be made on your request.

... there is no substitute for direct consultation with your board-certified urologist.

The information provided herein represents a brief overview of diagnosis and treatment options for common urological conditions. The information may be used to stimulate questions or concerns about urological issues. However, there is no substitute for direct consultation with a board-certified urologist.

Prostate Cryotherapy:

The No-scalpel Ice Treatment for Cancer

While prostate cancer can occur in any man, it is more commonly diagnosed in older men. Many such men have additional medical concerns such as hypertension, heart disease, high cholesterol or other medical problems which may pose special risks for anesthesia and surgery. While prostate cancer surgery is a time-tested effective method of prostate cancer management, surgery is not for everyone. Significant bleeding may occur during surgery, posing a special risk in some patients. Also, surgical incisions take time to heal, a time during which physical lifting and straining must be avoided. The radiation therapy alternative may be less effective than surgery, especially in patients with high grade and high stage prostate cancer.

The prostate becomes a ball of ice ...

For many years doctors sought a less invasive yet still effective prostate cancer treatment. Prostate cryosurgery (cryo) is such a treatment. The procedure uses ultrasound guidance for placement of needle-like cryoprobes through the skin into the prostate. Argon gas circulates through the needle-like probes, freezing the entire prostate. Temperatures within the prostate are as low as negative 120 degrees Centigrade (-120°C). The prostate becomes a ball of ice, which can be visualized easily by ultrasound. Small temperature probes placed within and around the prostate allow simultaneous temperature monitoring to assure adequate freezing of the prostate while maintaining the warmth of adjacent normal tissues. Warm water is circulated through a urethral warming catheter throughout the procedure to help preserve the urethra during as the prostate is turned to ice.

Once adequate freezing has been accomplished, helium gas is circulated through the cryoprobes resulting in thawing of the gland. The freezing and thawing processes is repeated as a second cycle before the cryoprobes and temperature probes are removed. The urethral warming catheter is maintained for 30-45 minutes after the treatment, until the prostate ice has thawed.

... ice this cold is known as "lethal ice."

Freezing and thawing of the tissue causes destruction of the cancerous and non cancerous prostate cells. The goal of treatment is complete destruction of all cancer and destruction of as much of the remainder of the prostate gland as possible. The prostate cancer cells are killed by ice formation within the cells, blood vessels and ducts of the gland. Prostate cancer cells are also killed by extreme intracellular dehydration with resultant denaturation of intracellular proteins, due to loss of water from inside the cells when ice causes rejection of solutes and concentration of body fluids outside of the cells. Freezing kills cancer cells in two ways. There is a mechanical killing of cancer cells and biochemical killing of cancer cells. Either way, there is only one possible outcome for cancer cells exposed to this kind of extreme cold... death. For obvious reasons, ice this cold is known to doctors and scientists as "lethal ice."

... cancer free rate of 89-92 percent ...

Although attempts to freeze the prostate began in the 1960's, modern prostate cryo using argon freezing and ultrasound guidance has been around less than ten years. Thus, intermediate term patient follow-up is only now becoming available for modern cryotherapy. Results are very promising but as with all prostate cancer treatments, a greater number of well controlled and longer term research studies are needed. The largest study reported to date Dr. D. K. Bahn described a cancer free rate of 89-92% in 590 patients. The criteria used to gauge the sucess of cryo in these patients is the very same criteria approved by the American Society for Therapeutic Radiology (ASTRO). This so called ASTRO criteria used by many cancer doctors to determine the sucess and failure rates of radiation therapy.

Using more stringent criteria to determine outcomes of cryotherapy, such as of a follow-up PSA of 1.0 or less, these same patients were judged to have a 76 percent rate of remaining cancer free at a median follow-up of about 6 years after cryo treatment. These results as published by Dr. Bahn are excellent, especially when taking into consideration that many of the patients studied had high risk prostate cancer. These high risk patients included patients with pretreatment PSA values greater than 10 (145 out of 590 patients), cancers of Gleason score of 7 or more (345 of 586 patients) and cancer estimated to cover nearly all parts of the prostate (in 104 of 576 patients -- stage T3).

Cancer is a life threatening disease and every treatment has possible complications. The cryo complications reported by Dr. Bahn in the series of 590 patients discussed above were incontinence of urine (defined as requiring the use of pads) 4%, impotence 95%, significant difficulty urinating in 5.5% and fistula formation 0.004%. A fistula is an abnormal opening between the rectum and the bladder which may be managed by simply leaving the catheter in the bladder longer than usual. However, there are reports of patients requiring surgery to repair fistulas or divert the urinary and bowel streams. A fistula is the result of an injury to the rectum.

Rectal injury is a risk of every form of prostate cancer treatment with old reports of rectal injury as high as 10% with surgery, 10% with cryo and 3% with radiation therapy. However, modern series have shown a reduction in rectal injuries to less than 1% with surgery and cryo. In fact, in the most recent prostate cryo study reported by Dr. David Ellis, no patient experienced a rectal injury or fistula. It appears that this complication is much less common as doctors move the the newer methods of cryo treatment. In the experience of doctors at the Urology Center beginning in early 2003, this problem is rare with no patient ever having had this complication. This is not to say that complications cannot happen. To the contrary, each doctor and patient must respect the possiblility of problems caused by all prostate cancer treatments and do everything with human power to avoid them. This is the strict and very sucessful policy at the Urology Center.

... Erectile dysfunction (ED) is a very common complication of any form of prostate cancer management.

Erectile dysfunction (ED) is a very common complication of any form of prostate cancer management. ED is primarily related to injury to tiny nerves that run on each side of the prostate entering the erectile tissue of the penis. Certainly cryo causes problems with ED in nearly 100% of patients... at least at first. However, as time goes by some patients (5-40%) experience a return of some or all of the ability to have penile erections. Unfortunately it currently is is impossible to predict which patients might experience this spontaneous improvement of erections.

In ... patients undergoing the focal nerve sparring cryotherapy procedure at the Urology Center, good results have been seen in terms of preserving erectile function.

There is now new hope for patients who who have normal erections before being treated for prostate cancer, yet who strongly desire to retain this ability. A new modification of the standard cryo treatment is known as 'focal nerve-sparing' cryo procedure as first described by Dr. G. Onik. The procedure involves cryo treatment of only the portions of the prostate involved with cancer, as predicted by mapping prostate needle biopsies. This is a new concept which goes against the tradition of treating the entire prostate gland. The one obvious increased risk of this procedure is the risk of leaving a portion of the cancer untreated. There also may be a risk that new cancer might develop in the portions of the prostate not treated. Long-term follow-up is needed before the safety of this approach is determined. However, studies in women with breast cancer have proven that there is no difference in the long term cancer survival of women that have part verses all of one breast removed for cancer. Could the same be true for men with prostate cancer treated by focal nerve sparing prostate cryo? Maybe, but it is too early to tell. Dr. Onik reports that seven out of nine patients who underwent the nerve-sparing cryo procedure continued to have normal erectile function after the procedure. These results are very preliminary. In very limited cases of patients undergoing the focal nerve sparring cryotherapy procedure at the Urology Center, good results have been seen in terms of preserving erectile function. However, these men continue to be followed very carefully for possible signs of prostate cancer.

In summary, rapid progress is being made with regard to the diagnosis and treatment prostate cancer. Modern prostate cryosurgery offers an excellent alternative treatment instead of surgery or radiation therapy. This treatment offers a less invasive outpatient effective treatment option which is attractive to most patients who learn of the availability of this option. Furthermore there are hopes of preserving erectile function by preserving nerves near the prostate and perhaps by preserving portions of the normal gland. The physicians at the Urology Center have experience with the evaluation and treatment prostate cancer by means of prostate cryoablation and focal nerve-sparing cryosurgery.

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(Please visit our Benign Prostate Enlargement Center of Excellence for other information concerning prostate disease. Also see related glossary terms: Benign Prostate Enlargement, BPH, Lower Urinary Tract Symptoms (LUTS), Prostate Microwave Procedure, Prostate Surgery, Prostatitis, Prostate Cancer, Bladder Cancer or visit Cryosurgery, American Foundation for Urologic Disease, Prostate, American Urological Association and American Cancer Society.)