Cryotherapy for prostate cancer

Cryotherapy is a treatment that uses extreme cold to destroy prostate cancer cells. It is also called cryoablation or cryosurgery.

You might have cryotherapy for prostate cancer that hasn't spread outside the prostate. This is localised prostate cancer. You may also have it for prostate cancer that has come back in the prostate after radiotherapy. Cryotherapy is only available in specific centres in the UK or as part of a clinical trial. 

What is cryotherapy?

Cryotherapy uses extreme cold to destroy cancer cells. During cryotherapy treatment, the doctors freeze the cancer cells to kill them.

Your doctor passes a special gas down thin needles that are inserted into your prostate. The gas then freezes the cancer cells.  

Who can have cryotherapy?

The National Institute for Health and Care Excellence (NICE) recommends using cryotherapy for prostate cancer only in specific centres or as part of clinical trials. NICE is an independent organisation that provides guidance to the NHS to improve healthcare. 

Your doctor might recommend cryotherapy if your cancer:

• is contained inside your prostate. This is localised prostate cancer
• is just breaking through the covering of the prostate. This locally advanced prostate cancer
• has come back after treatment with radiotherapy or brachytherapy

Before your treatment

Check your appointment letter for any specific ways to prepare for your cryotherapy. You usually have treatment at the hospital as an outpatient.

You might have an MRI or PET scan before the treatment. This is to find the exact position of the cancer so doctors can plan your treatment. 

You have this treatment under local or general anaesthetic. A general anaesthetic means that you are asleep and don’t feel anything. If you have a local anaesthetic, you usually have some sedative medicine to help you feel relaxed and sleepy.

You usually need to stop eating for 6 hours before the procedure but can still drink fluids. You stop drinking 4 hours beforehand.

Your doctor asks you to sign a consent form to say that you agree to have the treatment. This is a good time to make sure you ask all the questions that you have.

You need to make sure your bowel is empty before your cryotherapy. You might have an enema to do this. An enema is a liquid filled pouch with a nozzle, that you can put into your back passage (anus). This causes you to empty your bowels. Or you drink a laxative drink.

You change into a hospital gown before the procedure.

During cryotherapy

You have cryotherapy in the operating theatre if you have it under general anaesthetic. Or in a procedure room if you have it under local anaesthetic.

A surgeon puts a tube called a warming catheter into the urethra. The urethra is the tube that carries wee (urine) from the bladder out of the body. The warming tube protects the urethra from damage.

The surgeon then puts between 12 and 15 special cryotherapy needles through the skin of the perineum (the area of skin between your legs behind the testicles). They usually use a trans rectal ultrasound scan to make sure the needles are in the right place. Your surgeon puts the ultrasound probe into your back passage (rectum). This gives a clear image of the prostate on a screen.

A machine then sends gas through the needles to freeze the prostate area. The gas freezes and destroys the cancer cells. 

The surgeon uses temperature needles to monitor the temperature of other structures in the area such as the back passage (rectum). This makes sure these areas don’t get too cold.

The procedure usually takes between 1 and 2 hours.

The surgeon removes all the needles and any temperature probes once they've finished. 

When you are fully awake you go back to your ward or department to rest. The nurses check on whether you have any pain and will give you pain killers if you need them. It is normal to have some bleeding but the nurses will check the amount.

After cryotherapy treatment

You have a urine catheter to drain urine from your bladder. You might have this for a couple of days or it might be for 1 to 2 weeks.

Your surgeon tells you before your treatment how long you will need the catheter.

You can: 

• usually get up a few hours after the procedure. But avoid doing anything strenuous while the catheter is still in
• eat and drink when you're ready
• take painkillers as you need them

You'll have a dressing on the perineum area to keep it clean and dry. You also take a course of antibiotic tablets to help prevent any infection.

You won’t be able to drive home if you have a general anaesthetic, as it takes some time to wear off.

You might be able to go home that day or you might need an overnight stay. Your doctor will let you know what to expect.

After the treatment, the body’s immune system clears away the damaged prostate tissue over a few weeks.

Side effects

Your doctor explains all the potential side effects to you before you sign the consent form.

All treatment has risks and benefits and it’s important you have all the facts before your cryotherapy treatment. You might have some of these side effects:

• pain
• bruising
• constipation
• blood in the urine
• bleeding from the cryotherapy area

Let your doctor or nurse know if you have any side effects from your cryotherapy. There is a lot they can do to help.

Long term side effects

Possible long term side effects include:

• erection problems
• loss of control of urine (urinary incontinence)
• problems passing urine due to blockage of the urethra (the tube from the bladder to the tip of the penis)
• infection
• a hole between the bladder and the back passage – this is rare

You have regular check ups after your cryotherapy. Let your doctor know about any side effects that you have.

Clinical trials

The FORECAST trial is one study looking at scans and treatment for men with prostate cancer. Part of this includes seeing if they can safely treat just the area of cancer with cryotherapy, rather than the whole prostate gland. This is called focal cryotherapy. 

This trial has now closed and we're waiting for the results.