LEARNING
ABOUT PROSTATE CANCER 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 3 to 5 days.
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 multi-center study in 2003,
physicians, including Dr. Shore, conclude that cryotherapy
is less invasive and causes less trauma and fewer
side effects than radical prostatectomy.
Effectiveness
of Cryotherapy
Reports show a 70 - 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 30 to 40%*.
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.
Salvage cryoablation show a much lower occurrence
of rectal injury and incontinence when compared to
salvage radical prostatectomy.
*Modified from Brawer Rev Urol. 2002;
4(Suppl 2): S1
Cryotherapy
Myths & Facts
Myth: Cryotherapy is experimental.
Fact: Cryotherapy was approved by the FDA in
Coverage Decisions 1999 and 2001, 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. Recent
studies of ten-year results show further improvements
in both disease control and side effects.
Myth:
Cryotherapy is expensive.
Fact:
Cryotherapy costs far less than a radical prostatectomy
or radiation therapy. 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.
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