Cryotherapy for prostate cancer

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 inserts thin needles into your prostate.  A machine then sends gas through the needles. This freezes the prostate cancer cells.  

You can have cryotherapy to the:

• whole prostate gland 

• area of the prostate gland that contains cancer - this is called focal cryotherapy

Focal cryotherapy is the most common type of cryotherapy treatment.

Who can have cryotherapy?

The National Institute for Health and Care Excellence (NICE) is an independent organisation. It provides guidance to the NHS and develops recommendations about treatment. NICE recommends cryotherapy for prostate cancer only in specific centres or as part of clinical trials.

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 is 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. 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 might have an ​MRI​ or ​PET scan​ before the treatment. This is to find the exact position of the cancer. It helps doctors plan your treatment. 

You have this treatment under ​general anaesthetic​ .  Or you might have a spinal anaesthetic. Your anaesthetist puts a thin tube into your back to give a spinal anaesthetic. This means you feel nothing below the waist.

You usually need to stop eating for 6 hours before the procedure but can still drink fluids. Your healthcare team will tell you when to stop drinking beforehand.

You need to make sure your bowel is empty before your cryotherapy. You might have an ​enema​ to do this. 

You change into a hospital gown before the procedure.

During cryotherapy

You have cryotherapy in the operating theatre.

The surgeon puts a tube called a warming catheter into your ​urethra​ . The warming tube protects the urethra from damage.

The surgeon then puts special cryotherapy needles through the skin of the ​perineum​ .  You usually have between 3 and 5 needles. For whole prostate cryotherapy you might have up to 10 needles. 

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 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. They put in a catheter to drain urine whilst you are still asleep. 

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 you have the catheter

• 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. This is to help prevent any infection.

You won’t be able to drive home if you have a general anaesthetic. 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 treatment, your body’s ​immune system​ clears away damaged prostate tissue over a few weeks.

Side effects

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

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

Pain

You might have pain in the area between your testicles and back passage (rectum). You can take painkillers to help.

Blood in your urine

You might have some blood or small pieces of prostate tissue in your urine. This can last for a few weeks.  

Erection problems

At first you might have difficulty having or keeping an erection. For many men this goes back to normal. Treatments can help with erection problems.

Read about treatment for erection problems

Infection

Signs of an infection include pain passing urine or feeling cold or shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38°C. Severe infections can be life threatening. 

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

• 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.

Read about sex and relationships after prostate cancer treatment

Clinical trials

Researchers are looking at different treatments for ​metastatic​ prostate cancer. They are comparing ​hormone therapy​ with treatments that treat cancer inside the prostate. This includes cryotherapy.