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Patients who want pursue cryotherapy
as their first
line monotherapy, meaning they wish
to pursue this therapy without any other treatments,
should have these characteristics:
- Gleason
score of 6 or lower
- PSA
level of 10 or lower
- DRE
suggests no extension out of the prostate gland
- Prostate gland volume less than
50 cc
Not meeting all these criteria,
however, does not eliminate cryotherapy as a possible
treatment option. Read on to see who else is opting
for this therapy and why. Then speak to your doctor
to see if this treatment may be right for you.
Cryotherapy as First Line Monotherapy
for Prostate Cancer
Cryotherapy, like all prostate
cancer treatments, is most effective when used for
the right people. Cryotherapy for prostate cancer can
be used as both primary and salvage treatment. Patients
who opt for primary treatment should have a Gleason
score that is 6 or less in addition to a PSA level that
is 10 or lower. These numbers indicate that the prostate
cancer has been confined to the organ. Unlike brachytherapy,
cryotherapy can treat only localized prostate cancer.
Brachytherapy
extends a cloud of radiation around the prostate up
to 5 millimeters. Cryotherapy freezes only the tissue
that the needles touch. Prostate cancer that has spread
to the seminal vesicles will not be affected by the
minimally invasive procedure.
The prostate gland should also be
less than 50 cc. A large prostate volume may decrease
the effectiveness of the surgery. Patients who have
undergone a transurethral resection of the prostate
gland, or TURP,
however, may not be eligible for this prostate cancer
treatment. After undergoing TURP as a treatment for
benign
prostatic hyperplasia or BPH, a patient’s
prostate gland may no longer have an amount of tissue
sufficient for growing the ice balls used in cryotherapy.
Cryotherapy candidates should also have no evidence
of metastasis to the bones or lymph nodes, and who can
reasonably expect to live ten years or more.
Cryotherapy
as Salvage Therapy
When prostate cryotherapy is used as a salvage therapy,
it is usually after external radiation therapy has failed.
Those who have undergone permanent seed implantation
through brachytherapy cannot receive cryotherapy due
to the inert titanium casings. If PSA levels are rising
after having undergone external radiation therapy, a
biopsy is usually performed to confirm the presence
of the disease.
Neoadjuvant Hormone Therapy
and Cryotherapy
Hormone
therapy will often be used before undergoing cryotherapy.
The prostate gland surrounds the urethra and is bordered
by the bladder, the rectum, the seminal
vesicles, and neurovascular
nerve bundles. A warming
catheter is inserted into the urethra
to protect the bladder and urethra from the freezing
temperatures. Hormone therapy that shrinks the prostate
gland can put more space between the rectum wall and
the peripheral zone of the prostate gland. Shrinking
the prostate will give the surgeon a few more millimeters
to work with and minimize the freezing damage that could
be received by the rectal wall.
Other Factors in the Cryotherapy
Decision
Cryotherapy may be a viable prostate cancer treatment
option for patients who are not good candidates for
radical prostatectomy due to ulcerative
colitis, Crohn’s
disease, obesity (weight over 350 pounds),
and cardiac disease. Ulcerative colitis is an inflammation
of the colon and is closely linked with Crohn’s
disease which is an inflammation of the ending part
of the small intestine (called the ileum). Combined,
the two are usually called inflammatory bowel disease.
Cryotherapy for the prostate gland, however, is usually
recommended to those men who already experience impotence
or who are not interested in maintaining their potency.
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