Cryosurgical Ablation of the Prostate (Includes Ultrasonic Guidance and Monitoring)

Name of the Procedure:

• Common Name: Cryotherapy of the Prostate, Prostate Cryoablation
• Technical/Medical Name: Cryosurgical Ablation of the Prostate with Ultrasonic Guidance and Monitoring

Summary

Cryosurgical ablation of the prostate is a minimally invasive procedure used to treat prostate cancer. It involves freezing and destroying cancerous cells in the prostate gland. The procedure is guided and monitored through ultrasound imaging to ensure precision.

Purpose

• Medical Condition: Prostate cancer
• Goals: To eradicate cancerous cells in the prostate, slow the progression of cancer, and reduce symptoms associated with prostate cancer like difficulty urinating and discomfort.

Indications

• Diagnosed prostate cancer, particularly in cases where patients are not candidates for or prefer to avoid radiation therapy, surgery, or hormone therapy.
• Patients with localized prostate cancer or those who have recurrent cancer after radiation therapy.

Preparation

• Pre-procedure Instructions: Patients may be instructed to fast (no food or drink) for several hours before the procedure. Medication adjustments such as pausing blood thinners may be required.
• Diagnostic Tests: Blood tests, imaging studies like MRI or CT scans, and a detailed ultrasound examination will be performed to plan the procedure.

Procedure Description

1. Anesthesia: The patient is typically placed under general anesthesia or spinal/epidural anesthesia.
2. Initial Setup: A transrectal ultrasound probe is inserted to visualize the prostate gland.
3. Insertion of Cryoprobes: Thin needles (cryoprobes) are inserted through the perineum (skin between the scrotum and anus) into the prostate.
4. Freezing Process: Argon gas is circulated through the cryoprobes, causing the prostate tissue to freeze and form ice balls, which destroy the cancerous cells.
5. Monitoring: Throughout the procedure, ultrasound imaging is used to monitor the placement of the cryoprobes and the formation of the ice balls to ensure that only targeted tissues are treated.
6. Thawing and Repeat: After freezing, helium gas is used to warm the tissue. The freeze-thaw cycle may be repeated several times during the procedure for effectiveness.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or specialized outpatient surgical center.

Personnel

• Surgeon: Typically a urologist with specialized training in cryotherapy.
• Nurses: Assist in preparation, during the procedure, and post-procedure care.
• Anesthesiologist: Manages anesthesia and monitors the patient’s vitals.

Risks and Complications

• Common Risks: Swelling, bruising, or pain in the treated area, blood in urine, urinary retention, or infection.
• Rare Risks: Injury to the rectum, urethral sloughing, erectile dysfunction, and urinary incontinence.

Benefits

• Minimally invasive with a shorter recovery time compared to traditional surgery.
• Can be an option for patients who are not candidates for surgery or radiation.
• Can be repeated if necessary.
• Symptoms improvement and reduced cancer progression are typically seen within a few weeks.

Recovery

• Post-procedure Care: Patients may go home the same day or stay overnight. They may need a catheter for a few days.
• Instructions: Avoid heavy lifting, strenuous activities, and sexual activities for a specified period (usually a few weeks).
• Follow-up: Regular follow-up appointments to monitor recovery and check for cancer recurrence.

Alternatives

• Other Treatments: Radiation therapy, radical prostatectomy (surgical removal of the prostate), hormone therapy, and active surveillance.
• Pros and Cons: Radiation and surgery may offer longer-term cancer control but come with higher risks and longer recovery. Active surveillance involves regular monitoring without immediate intervention.

Patient Experience

• During Procedure: Patients will not feel pain due to anesthesia but may feel pressure during probe insertion.
• After Procedure: Some discomfort, bruising, and swelling are common. Pain management will be provided, and most patients can resume normal activities within a few days, with complete recovery taking a few weeks.