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Prostate Cancer Freezing Treatment
by Chris Podbielski
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Overview
Prostate Cancer Freezing Treatment
Although the survival rate of men diagnosed with prostate cancer remains relatively high (nearly 100 percent for five-year survivors), the American Cancer Society projects one in six men in the United States will contract the disease. As always, early detection and treatment remain important to long-term survival. Physicians offered cryotherapy, also known as cryoablation and cryosurgery, as one choice for treating prostate cancer since 1974.
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Function
Doctors performing cryosurgery insert metal probes cooled with argon gas or liquid nitrogen into the prostate gland to freeze the cancerous mass. Argon cools the probe much faster than liquid nitrogen and requires smaller probes. During the process, doctors guide each probe via transrectal ultrasonography (TRUS)---a rectal sonogram used to monitor placement and size of the freezing area. They also insert a warming catheter to prevent freezing of the urethra. Focalized cryoablation allows the physician to administer either a general or local anesthetic, which means the possibility of out-patient treatment.
Nodular Hyperplasia of the Prostate---Prep4Med, Flickr
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History
Dr. James Arnott won honors at London's Great Exhibition in 1851 for his work in cryotherapy, and used salt and ice mixtures to treat breast, cervical and skin tumors in his practice throughout the nineteenth century. In New York just before the turn of the century, Campbell White published his findings on the use of refrigerants to treat a variety of masses, a much more effective treatment because of the colder temperatures reached. Setrag Zacarian introduced copper probes that allowed for penetration up to seven millimeters deep in the late 1960s.
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Benefits
Today, cryotherapy takes two to three hours with a recovery period of two to four weeks, and may be performed on an out-patient basis. The treatment zeroes in on the tumor itself, leaving the rest of the prostate gland unaffected. Medicare approved reimbursement of cryosurgical procedures for prostate cancer in 1999.
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Considerations
Not all men are eligible for cryoablation. If the tumor is large (over 40 grams) or the cancer spreads beyond the prostate, the patient should undergo a different form of treatment. Doctors advise men with high Gleason scores (determined by the microscopic appearance of the glands---lower scores denote a more uniform appearance with small spaces between glands while higher scores show cells clumping together) to consider radiation or surgery instead. Also, cryotherapy carries many long-term, negative consequences.
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Effects
Most cryosurgery patients experience some level of erectile dysfunction for years after the procedure, due to damage to the penile blood supply. Regained functionality escalates with therapy or the use of marital aids. A few experience incontinence, though rates of dysfunction increase for men who undergo cryoablation after a failed treatment of radiation therapy. Infection may occur. Dead tissue cells may clog the urethra, though physicians prescribe catheter use for several weeks to prevent inflammation and urethral blockages.
