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. 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 a Foley catheter in the bladder for at least 3 days after the procedure, and our nursing staff 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. The option of anesthesia will be discussed between the patient and the anesthesiologist. After meeting, we will decide between general and spinal 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; therefore, there is minimal bleeding and no wound care or bandage/dressing. 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 treated.

What kind of follow-up is there?
In terms of follow-up, following cryosurgery patients return to my office in 3 to 5 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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