LEARNING
ABOUT TREATMENT
An
exciting development in prostate cancer treatment has
occurred with cryosurgery, which is more aptly called
"cryotherapy" today. Because it is minimally
invasive, prostate cancer cryotherapy has fewer complications
than surgery. The goals of minimally invasive therapies
are:
- To
destroy the local disease
- To
shorten hospital stay
- To
reduce the number of postoperative morbidities
- To
shorten recovery time
- To
reduce the cost of the procedure
How
is Cryotherapy performed?
The procedure is performed in the operating room, and
the patient receives anesthesia. There is no incision;
approx. six needles are inserted into the prostate to
freeze the prostate and destroy all prostate cancer
cells. During the procedure, the prostate and needle
placement are evaluated with ultrasound imaging. Argon
and helium gas circulates through the needles providing
the doctor with controllable freezing and thawing capability.
The temperature within the prostate is lowered to -40°C
for several minutes, creating ice balls which kill cancer
cells. The patient usually goes home that day and a
urethral catheter drains urine into a bag on the thigh
for one week.
The
Benefits of Cryotherapy
The benefits of the procedure include a choice of general
or regional anesthesia, a fast recovery and lower risk
of potential side effects, such as incontinence. Cryotherapy
does not involve radiation or radioactive substances
(seeds) that are left in the body. And unlike radical
prostatectomy, cryotherapy is not major surgery. This
means that patients are back on their feet and back
to their lives quickly. Recent studies have shown that
for some men cryotherapy may be performed with minimal
damage to the nerves necessary for sexual function.
According to a study featured in the Journal of Urology
October 2001, physicians, including Dr. Katz, conclude
that cryotherapy is less invasive and causes less trauma
and fewer side effects than radical prostatectomy.
Effectiveness
of Cryotherapy
Reports show a 80% cure rate. Most studies have also
shown significant decreases in the prostate specific
antigen (PSA) in blood tests with no evidence of prostate
cancer in repeat biopsies of the prostate after cryosurgery.
Are
You a Candidate?
Choosing a treatment for prostate cancer isn't easy.
Today's traditional choices include surgery, cryotherapy,
radiation and hormone therapy. Each of these may be
used alone or in combination. Whether you have first-time
or recurrent prostate cancer, there's a good chance
you're eligible for cryotherapy - as long as your cancer
has not spread beyond the prostate. Of course, only
a qualified doctor will know for sure.
Salvage
Cryotherapy
To date, the gold standard therapies for clinically
localized prostate cancer include radical prostatectomy,
and radiation therapy (external beam and brachytherapy).
Prostate biopsy and serum prostate specific antigen
(PSA) data following these therapies suggest recurrent
and residual disease rate ranging from 25% to 93%. However,
some of these patients will be candidates for salvage
therapy because of locally recurrent disease and a good
health condition. The goal of these salvage therapies
is to improve local control and possibly impact long-term
survival. For patients who have radiation therapy failure,
four therapies can be proposed: salvage prostatectomy
or cystoprostatectomy (with high risk of complications),
salvage brachytherapy, hormonal therapy and salvage
cryoablation of the prostate.
Cryotherapy
Myths & Facts
Myth: Cryotherapy is experimental.
Fact: Cryotherapy has been approved by the FDA, is covered
by Medicare and has been performed on thousands of patients
by hundreds of doctors nationwide each year.
Myth:
Cryotherapy has serious side effects.
Fact: Years ago, patients suffered damage to the urethra
and surrounding tissue because doctors lacked the right
imaging technology and temperature monitoring tools.
But today, ultrasound technology guides both the probe
placement and the freezing process. In addition, temperature
sensors and a urethral warming system ensure that surrounding
tissue, including the urethra, does not get too cold.
Myth:
Cryotherapy doesn't work.
Fact: A recent study showed that 97.6% of patients treated
with new-generation minimally invasive cryotherapy were
still cancer-free after twelve months. Long-term follow-up
data using the ultra-thin 17-gauge needle technology
is not yet available, although open studies with cryotherapy
have demonstrated up to 95% of survival at seven years.
Myth:
Cryotherapy is expensive.
Fact: Cryotherapy costs far less than a radical prostatectomy.
It is covered by Medicare, as well as most insurance
plans and VA hospitals, making it accessible and affordable
for virtually any patient.
Risks
of Cryotherapy
The main risk associated with prostate cryotherapy is
impotence. This may occur since in order to insure the
destruction of all cancer cells, the goal is to freeze
tissue beyond the prostate. In doing so, nerve bundles
associated with erection may be affected. However, these
nerves can regenerate and depending on potency prior
to cryotherapy, it may return over a period of time.
In a recent study, doctors found that at three years
after cryosurgery, patients' reported quality of life
was not worse than that of men treated with radiotherapy,
radical prostatectomy, brachytherapy or with being observed.
The only exception was erectile dysfunction, which improved
with the use of aids and the passage of time.
Side
Effects of Cryotherapy
In some patients, incontinence or urethral scarring
may be a side effect following cryotherapy. In most
cases the symptoms are resolved in a few weeks. Other
possible side effects include:
- Moderate
pelvic pain
- Blood
in the urine
- Mild
urinary urgency
- Scrotal
swelling
These
side-effects usually go away within a few weeks. Most
men recover their normal bowel and bladder function.
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