FREQUENTLY
ASKED QUESTIONS
Am
I a candidate for cryosurgery?
The patients that I believe are the best candidates
for cryosurgery are those with:
- localized
prostate cancer
- radiation
recurrent disease
- high-risk
prostate cancer (elevated PSA >10 and a Gleason's
score of 7 and above)
Also,
I have recently started treating patients with low risk
prostate cancer in the focal manner. Focal cryosurgical
ablation appears to be well suited for patients with
early stage prostate cancer who have a minimal amount
of prostate cancer localized to one area of the gland.
I
have had radiation therapy. Can I have cryosurgery?
The answer to this question is a definite yes. The majority
of my patients, nearly 70% of my practice, are patients
that have had previous radiation therapy, either external
beam or seed implantation, or a combination, and have
had a biopsy proving recurrence in the prostate gland.
The
overall side effects in my experience are minimal but
there can be some incontinence, although this has been
reported as less than 5% of the patients. In my own
experience, 97% of my patients are still alive after
10 years with salvage cryosurgery and I feel that this
is an excellent modality for patients with this type
of disease. The only other options for these patients
would either be hormonal therapy, watchful waiting,
or to consider a salvage radical prostatectomy. However,
I feel that a salvage radical prostatectomy offers no
statistically significant increase in overall survival
and may be fraught with a higher complication rate even
in experienced hands.
How
long will I be in the hospital?
Cryosurgery is now mostly an outpatient procedure.
Over
the past two years, I have changed my approach to discharging
patients. In the past, I had kept all the patients overnight
but now all of my patients go home. I do not feel that
there is any need for hospitalization at this time.
There is no real bleeding or pain or any fluid shifts,
and therefore patients can go home following the procedure.
You should understand that when you do go home you will
have either a Foley catheter in the bladder or a suprapubic
tube for at least 5 days after the procedure, and our
nursing staff here at the hospital will teach you how
to take care of this catheter. While you have the catheter
in, you can still go outside, you can drive a car, you
can even go to restaurants.
Will
my insurance cover cryosurgery?
Thankfully, as of several years ago, Medicare has approved
cryosurgery as both a primary and salvage procedure,
and Medicare will also cover the brief hospitalization.
In my practice, we do take other commercial carriers
and you should call my office to find out if you are
under those plans. If not, we will work with your insurance
carrier to help pay for the procedure; however, there
will be an upfront cost to you. In the majority of my
patients, 80% of our fee is reimbursed to you by your
insurance carrier.
What
kind of anesthesia will I have?
The majority of my patients have cryosurgery under spinal
anesthesia. I do not feel that general anesthesia is
required. I feel that with spinal anesthesia the patients
recover quickly, they feel no pain, and do not have
the long-lasting sedative effects of general anesthesia.
Will
my potency be affected?
In the past, cryosurgery had the highest risk of impotence,
nearly 100%. This is still true today, especially if
cryosurgery is performed in a manner where the gland
is completely frozen; however, recently we have added
the temperature monitoring devices in the neurovascular
bundles to monitor the temperature. If you have low
risk prostate cancer or have unifocal disease, the neurovascular
bundles can be preserved and potency can be maintained.
Even if cryosurgical ablation is required and complete
ablation is performed, there has been regrowth of nerves
in this area and a subset of our patients have had return
of their sexual function, especially when using oral
agents such as Viagra, Levitra, or Cialis.
I
have unifocal disease. Is there a "nerve-sparing"
cryosurgery?
The concept of focal cryosurgery is to freeze that area
of the involved prostate gland and leave the other side
unfrozen. This has the potential advantages of causing
no urinary or sexual dysfunction, but may leave unfrozen
prostate cancer on the other side. Even if the biopsy
did not reveal cancer, there can still be areas of small
cancer that were not detected on biopsy. Therefore,
I recommend that if you are considering focal cryoablation
that you should have a thorough consultation in my office
and also have a follow-up biopsy 1 to 2 years after
the procedure.
When
can I drive or go back to work or exercise?
The majority of my patients can drive within a day or
two and go back to work in one to two weeks.
Even
though they have a catheter in the bladder, the catheter
is connected to a leg bag which is placed around your
thigh and the urine is collected in this bag. It is
possible for you to drive a car or go out to restaurants
at this time. In terms of going back to work, this depends
upon the amount of physical exercise and physical energy
that is required at your job. If you have a desk job
the majority of the patients can return to work in one
week. If your job requires more physical labor, then
I would recommend at least two weeks from work.
Compared
to radical surgery, how invasive is it?
The idea behind cryosurgery is to place small needles
through the skin and into the prostate and freeze the
cancer. This will kill the cancer. This procedure is
noninvasive in that it does not require an incision,
there is no bleeding. The procedure is monitored under
ultrasound and small temperature devices are placed
in and around the prostate gland to monitor the temperature
and insure that the entire gland is ablated.
What
kind of follow-up is there?
In terms of follow-up, following cryosurgery patients
return to my office in 5 to 7 days to have the catheter
removed. Once this is removed I see the patients back
in 2 to 3 months and obtain a PSA and do a physical
examination. I recommend that all of our cryosurgical
patients have a physical examination and PSA every 4
months for the first 2 years, and then every 6 months
thereafter. There is no need for additional biopsies
(unless you have focal cryosurgery, see above or if
the PSA should rise). If the PSA does rise, and has
risen three times in a row, then I would recommend a
repeat prostate biopsy.
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