Cryosurgery for prostate cancer
Cryosurgery (or cryoablation) is still an experimental treatment, and trials are in progress to monitor its safety and effectiveness. National Institute for Health and Care Excellence (NICE) has issued favourable guidance but treatment is only available in specialist centres in the UK and only as part of a clinical trial.
Cryosurgery uses extreme cold, in combination with ultrasound and temperature monitoring, to destroy cancer cells in and around the prostate gland. During cryosurgery the patient is given a general or epidural anaesthetic. A thin catheter that circulates warm fluid is place in the urethra to protect it from cold temperatures. Next, six to eight slender cryoprobes are inserted through a small incision into the prostate gland. Liquid argon is circulated at the tips of the cryoprobes. This begins the cooling process, during which the cryoprobes freeze tissue symmetrically round the probe tip, eventually freezing the entire prostate gland. Tissue that reaches minus 40C is destroyed. After approximately ten minutes the surgeon completes the first freeze cycle, and then administers another treatment to help ensure that all the cancer cells are killed. Following cryosurgery the patient may spend a night in hospital or return home the same day. The patient goes home with a catheter in place to help with urination the week following treatment.
Some patients experience mild swelling or soreness after cryosurgery, and long-term complications may include impotence, incontinence, and rectal injury. Despite its use in the USA it remains a new therapy in the UK and it is not widely available on the NHS. At present, funding comes partly from the NHS and partly from charitable donations. Two of the men who describe their experiences chose cryosurgery as a first line of treatment for their prostate cancer, (although one of these men had already had an orchidectomy for another problem). However, cryosurgery may also be used when radiation therapy has failed, and when treatment options are very limited. One man in this situation also describes his experience of cryosurgery in the United Kingdom.
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- Age at diagnosis:
I must admit when I read the results from the Internet, cryotherapy struck me as being useful rather like Brachytherapy but they're using a very, very cold Argon gas that freezes the prostate to death.
I spoke about all the various possibilities with the consultant, and he said cryotherapy is not available in England. So I said 'In that case let's go for Brachytherapy,' which I understood then was available in Leeds and in London. And he went off to refer me for Brachytherapy. Literally the next day I saw in the Telegraph that Mr X down in X Town was in fact going to start up with Cryotherapy and I went back to see the consultant, and said 'Oi what about this?' and he read the article, took a photocopy of it and promptly referred me.
And I put this to my GP and he said 'Yes you're absolutely right but at the present time we have to put certain treatments out to tender and cancers are covered for our particular practice by [Hospital] so if you like your treatment has already been paid for in advance and that's somewhat different to having to come up with the cash to pay for your treatment now. But he said 'Leave it with me,' and a month later he came back and said 'It's fixed.' So I was very lucky and I was treated under the National Health.
I went down to the operating theatre somewhere about 10, 11 in the morning I was given a general anaesthetic and the next thing that I remember I was in bed and it was 4 o clock in the afternoon and everything had gone well.
After the cryosurgery I was a bit battered and bruised down below. One of the things Mr X had to guard against is that whilst he was happy, willing and raring to freeze my prostate to death, once that had happened it would be absorbed into the body, there were certain parts that he didn't want to freeze and so warm saline solution was pumped in and out of those parts to keep them warmed up. But I was pretty badly bruised and swelling and all the rest of it and he decided that he should give those working parts a bit of a rest and I had a secondary plumbing system inserted just about the navel, and I wore a bag for about a month. That was inconvenient.
This is for urine?
That's for urine yes, that was for urine. It was inconvenient but certainly the month I had the bag all the bruising went and the stitches were removed and the bag was eventually removed and I've had no urinary problems since.
And what about sexually because that's another thing a lot of men worry about, particularly with the other forms of treatment where you can have problems with erections and things like that?
Well yeah I have had a problem there but I was warned that that might be the case and might last for a year or so and yeah I still have a problem there. If I was 30 it might be a greater problem but I'm not.
I would say that at no time prior to or after my treatment have I ever had any pain or any reactions to the treatment whatsoever.
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Radiotherapy I didn't want, I wasn't interested in that, I thought it was far more destructive than healing in my opinion. I was offered prostatectomy, no I wasn't offered prostatectomy sorry, I was too old for prostatectomy, I was told they only did it if you were below 70 and I was 71. That would've been my choice if I, if I had a choice but I went onto these Depo injections and I think I would've stayed in the Depo injections unless, well until I saw one article in the Telegraph. There was a consultant at X Town who was doing, who was going to set up a surgery doing cryogenic surgery on the prostate.
Cryosurgery is freezing of any part of the body down below 155 degrees Fahrenheit, it freezes whatever the probes are put into and it disintegrates that part of the body which falls away. Probes are placed into the prostate, around the cancer and then it is frozen and that falls away inside your body and the body disposes of it. There are heaters placed to protect certain vital parts of your body, say your anus and your urinal tract and these are carefully monitored. It's a 6 hour operation but it is very painless, there's no after effects. And 3 days after the operation I was able to walk out the hospital and come home although I did have...
A catheter in my, which I used to carry around for 3 weeks. And I had to drink 8 pints of water a day which was no problem plus coffee and tea and I found the catheter very convenient really because I didn't have to look for a toilet when I was out, or in the garden even. And sleeping was no problem, what else?.
So when you went into hospital to have the cryosurgery did you go in the night before?
No I went in at 8 o'clock, no breakfast, and had the operation that started 2 o'clock and it finished at 8 o'clock in the evening, when I came round. I was covered with a heating blanket and a foil blanket, very, very cold, which only lasted about half an hour I suppose and I had a supra-pubic drain placed in my stomach which I passed my urine through and I had a flushing catheter put into my penis which flushed the, my urine out and my bladder and I had 6 spots just behind the testicles where these probes went in and apart from that I didn't feel anything really. They stripped it all out after about 2 days and left the super-pubic drain in and I was, well ready to go home really.
The catheter in my penis came out after about 2 days and I was left with, with just the supra-pubic drain into my stomach which I passed urine through.
So the drain that you came, the catheter that you came home with for passing, that came out of your stomach did it?
It did yes yeah, yeah.
And yeah as I say it was quite convenient. All I had to do was just connect up a new bag every day and at night I put on a, connected up to a much larger bag because I was drinking so much liquid and I found it very convenient, I didn't have to get up during the night to go to the toilet [laughs] so I was able to get a good night's sleep you know. And when I came home, I went in on the Tuesday, I came home on the Friday and I was fully mobile and I could do most things. And they, the consultant said 'Do what you can, if you feel like you can do it do it you know.' I was unable to drive the car for 3 weeks but apart from that I could do most things. I did gardening, digging and the operation itself was absolutely painless and no discomfort at all.
So having that cryosurgery I am back to what I was when I was a scho
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Why did you decide to have cryoablation after having had the radiotherapy, did they discuss it?
Well that's all there was because, because it [cancer] came back you know and the PSA was going up and up and up again but it hadn't yet gone outside, so of course fortunately we had cryo by that time, just... Hence me being one of the first two to try it. And I mean it's come back and that's what you've got available, you take it.
And did they do the surgery on the NHS, was it paid for by the Government?
Oh yes, oh yes. But of course the charity has since replaced it all. I really started this charity once I got the cancer and we have Heal funding, I'll give you a couple of leaflets to take way with you, Heal funding which of course is doing research, holistics and of course mainly my side of it is the supply of equipment.
So can you describe the day when you went into hospital to have the cryosurgery from the beginning to the end please.
Yes the, one is merely prepared for an operation as any other operation, normal checks on general fitness other than the obvious problems that you're in there for. Then the following day of course it's pre-med and the operation that was supposed to take 2 hours finished up taking, well I was out of the ward for 8 hours, but of course you have 3 catheters for cryoablation, one of course in the stomach, one in the perineum and the other to keep the urethra warm. I'll leave it to your imagination where they put the third one.
So the urine is draining out through the stomach?
It's out through the stomach yes because the other one is put in there merely because if you didn't of course you would do great damage of course if you weren't to keep the urethra warm whilst you're operating.
And did you have a general anaesthetic for this?
General yes. You know I have read the reports that of course this could be done under local but 8 hours under local, forget it you could not do this under local, you'd have to have I feel a general anaesthetic.
Why did yours take so long do you know?
And can you explain in as much detail what happened afterwards?
It may well be it took a long time because of course Dr X would have been explaining every part of the procedure, not only to the urologist but the oncologist was also there, together with the registrars.
And can you explain exactly how it felt when you came round and what happened please in as much detail as possible?
When I came round it was not, no different basically than coming round from any other surgery. Obviously very sore - the thing that quite surprised me most of all was the total shrinkage of whatever equipment I'd had when I went in there had totally, and of course there is still after all this time a very stinging numbness. But it's purely a question of alternatives, I mean I would, and of course what's important of course is you can have cryo again and I think that is terribly important because if it flared up again you can have another lot of cryo where of course radiotherapy you can have so much and that's finished.
And how long were you in hospital for?
6 days, 5 to 6 days yes including the day I went in I suppose that would be 6 days.
Last updated March 2015.