Treatment for prostate cancer depends on the stage of the disease, age and health of the patient, and the effectiveness of the available treatment options available. A new and innovative therapy for prostate cancer called cryosurgery has been first introduced in Northeast Ohio by Stephen W. Leslie, MD. Cryosurgery, also called cryoablation and cryotherapy, is a minimally invasive procedure that kills cells and tumors by rapidly freezing and thawing the tissue. It is a safe and effective treatment for many prostate cancer patients including some who would otherwise not have any curative therapies available to them.

The procedure is recommended only for those patients where the prostate cancer is confined to the prostate itself. (If the cancer has already spread to other parts of the body such as the lymph nodes or bone, then cryosurgery will not be able to cure the disease.) It is recommended for older patients and for those where radical prostate surgery, radiation therapy or radioactive seed implants cannot be done or are undesireable for some reason. Cryosurgery is particularly well suited for three groups of patients.

1. Patients who have developed a recurrence of their prostate cancers following external beam radiation therapy or radioactive seed implants. These patients cannnot tolerate additional radiation therapy and no other curative treatment option is available except for cryosurgery.
2. Patients whose prostate cancer indicates high risk factors such as a PSA >10, aggressive microscopic appearance of the cancer (Gleason score >6), and extensive involvement of the prostate itself.
3. Patients where significant medical problems or age make radical prostate surgery too risky.

Prior to surgery, a transrectal ultrasound with biopsies of the prostate is usually done to identify the precise extent of the cancer. Imaging studies including a CT scan, Prostascint scan and/or bone scan may also be performed.

The procedure may be performed under either a spinal or general anesthetic depending on the patient's preference and medical condition. The patient is then placed on his back with his legs elevated to provide access to the prostate through the skin area between the rectum and scrotum. A suprapubic tube is placed to allow the urine to drain from the bladder after surgery until the prostate heals sufficient to allow normal voiding. This usually takes 1-2 weeks.

A warming catheter is then placed through the penis into the bladder. This catheter protects the passageway from any damage during the freezing of the prostate. An ultrasound probe is placed in the rectum so the surgeon can clearly see the prostate and surrounding tissue as well as the cryoprobes while will be used to freeze the prostate. The surgeon then carefully places the cryoprobes, usually six, through the skin between the rectum and scrotum and into the prostate. Their position is checked and monitored by ultrasound. Five temperature probes are placed around the prostate to monitor the temperature and help prevent damage to surrounding tissues such as the rectum. Argon gas is then circulated through the cryoprobes in a carefully regulated pattern to create an iceball that surrounds all the prostate tissue and cancer. The prostate is frozen to -40 degrees C and then allowed to thaw. This process is repeated and then the instruments are removed. The entire procedure takes about two hours.

Patients usually go home the same day or at most stay overnite one day. The catheter is usually necessary for about 1 week in most patients but may have to stay longer in some men until they void well on their own. Some pelvic pain may remain for up to several months in some patients, but most report very little discomfort and often recover fully within days of the procedure, compared to weeks or months of recovery that is associated with other surgeries and treatments.

The urethral warming catheter and careful temperature monitoring are chiefly responsible for the very low incidence of complications like incontinence (1%), fistula formation (1%) or urinary obstruction (1%) associated with the procedure. There is almost a 100% chance of impotence (erectile dysfunction or ED) resulting from the procedure due primarily to damage done to the nerves that run just outside the prostatic capsule. However, physicians are developing nerve-sparing techniques that should help reduce this rate in the future.

Nearly ten thousand men have undergone cryosurgery for prostate cancer in the United States. Recent studies show that 97% of patients are cancer free at 1 year and 82% are cancer free at 5 years following the surgery. In high risk patients who have failed radiation therapy for their prostate cancer and where no other curative therapy is available, 65% remain cancer free after 3 years following cryosurgery. A significant advantage to cryosurgery is that unlike radiation, cryotherapy can be repeated in most cases if a recurrence develops.

Cryosurgery of the prostate is approved by the FDA and is covered by Medicare as well as many private insurance companies.

For more information about cryosurgery, you can contact the cryotherapy patient information service at 1-877-722-2796 or call the Amherst Ohio office of Dr. Stephen W. Leslie at: 440-985-9898.