Cryotherapy is a technique used for prostate cancer treatment that involves controlled freezing of the prostate gland.*

Cryosurgery, sometimes called cryotherapy, is the localized freezing of tissue for the controlled destruction and removal of unwanted lesions, especially on the skin.

Cryosurgery is a method of killing tumor cells with extreme cold temperatures using liquid nitrogen. The tumors best treated with cryosurgery are small, benign masses less than one inch in diameter. Typically, these masses are located on the eyelid, anus, mouth, or skin. Depending on the location of the tumor, the patient may require sedation, local anesthesia, or general anesthesia to perform cryosurgery.

Cryotherapy is an option for prostate cancer patients who want to avoid major surgery. Patients with smaller prostates are better candidates for treatment. Those with larger prostates can undergo therapy to decrease the prostate size prior to cryotherapy.

Presently, cryotherapy is recommended for patients who have localized prostate cancer or have recurrence of prostate cancer despite radiation.

Cryotherapy works by creating a cooling sensation that is transmitted through the nerve endings to the brain. It transmits at speeds faster than most pain sensations or warming sensations. Unlike icing an area, Biofreeze allows blood to continue to flow to the area so that it can be naturally repaired.

Unlike a prostatectomy, cryosurgery attempts to destroy prostate tumor tissue in place, without removing it.

Currently, research is being done to determine the effectiveness of cryotherapy for tumors of the brain, kidney, bone, lung, and spine. In addition, researchers are evaluating its usefulness in freezing and shrinking benign breast lumps.

The best candidates for cryotherapy are men with Stage T1-T3 disease. Men with high Gleason scores and PSA levels in particular should consider cryotherapy (see Fact Sheet for an explanation of Gleason scores). In these patient populations, cryotherapy has been found to be safe, effective and medically necessary. Because targeted cryo can be repeated if all the cancer cells aren't destroyed, some patients choose the treatment for this reason.

In addition to Brymill’s FREE 13-minute DVD, there are textbooks, CME workshops, and a Brymill training CD-ROM providing cryosurgical instruction. You can order the following through Brymill: Liquid Nitrogen Cryosurgery: An Overview (Brymill’s FREE 13-minute demonstration DVD) Call Brymill for a copy.

The decision regarding treatment for prostate cancer is a very personal one. It is a cancer that has multiple treatment approaches with different complications and cure rates.

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.

Targeted cryosurgery is a procedure developed by Endocare, Inc. It uses the application of extreme cold in combination with ultrasound and temperature monitoring to precisely destroy cancer cells in and around the prostate gland. When extreme cold is introduced into the prostate gland, the prostate tissue is destroyed, including cancerous cells.

During the procedure, the patient is under either general or epidural anesthesia and experiences no pain.

In the August 2002 peer-reviewed supplement of the journal Urology results of a seven year study of 590 cryo patients found that 92% of low-risk cancer patients, 89% of moderate-risk patients, and 87% of high-risk patients were disease free. In another study presented at the 1998 World Endo-Urology Conference, 97% of patients treated with targeted cryosurgery showed no signs of cancer at one year.

Thousands of men have chosen cryo to treat prostate cancer. This therapy, first introduced in the 1960s, has seen dramatic improvements during the past eight years with the use of temperature monitoring, argon-based cryogen and ultrasound guidance techniques. The temperature monitoring and ultrasound visualization used in targeted cryotherapy allow the physician to precisely freeze the prostate gland while sparing other critical areas of surrounding tissue.

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.

Different cryo procedures are performed under different visualization. Some procedures are performed laparoscopically, also referred to as minimally invasive keyhole surgery. A tube with a light and a camera lens at the end is inserted through small incisions in the abdomen. Imaging modalities, including ultrasound, CT and MRI are used by the physician to guide the needle placement as well as monitor the freezing process.

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.

Highly effective treatment and removal of many warts and other common skin lesions - For example, in a study of 96 patients with 505 Plantar Warts who saw one physician over a 16-month period, 92% of the warts cleared completely after cryosurgery (84% after only a single treatment). Treatment is easy, quick, and convenient to perform - The average freeze time for common lesions is 5-30 seconds.

In clinical experience in Europe, CryoTherapy has been shown to be safe and effective in treating all arrhythmias. It is particularly effective in treating peri-nodal accessory pathways and AVNRT arrhythmias. It is showing very promising results in the treatment of AF.

Cryotherapy has applications for a range of cancer treatments in addition to treatment for benign or non-cancerous tumors. There is a wealth of clinical data on prostate cancer and renal cancer cryo treatments. Additional studies have been done on cryosurgical treatments for liver, thoracic, and bone tumors, as well as benign breast fibroadenoma.

One or more ultra-thin, 17 gauge (1.47 mm) cryoablation needles are inserted percutaneously (through the skin) directly into the tumor, with no incision. Once inserted into the tumor, the cryoablation needles are cooled to sub-zero temperatures according to a predetermined freezing and thawing protocol. The physician sculpts a freeze zone to engulf and destroy the cancerous area, whether it is the entire prostate gland, kidney tumor or other tumors.

Major innovations include the use of advanced gas expansion method (Joule-Thomson principle), small diameter needles, and support for monitoring using ultrasound, CT or MRI imaging. These advancements have contributed to significant improvement in controlling the freezing process and allowing cryosurgery to be offered as a minimally invasive procedure.