What is Cryotherapy for Prostate Cancer?

Cryotherapy, also known as cryoablation, is a minimally invasive procedure used to treat prostate cancer. It involves freezing and destroying cancerous prostate tissue. Thin needles, called cryoprobes, are inserted through the skin between the anus and scrotum (perineum) into the prostate gland. Extremely cold gases are then passed through these needles, creating ice balls that freeze and kill the cancer cells. The dead tissue is then naturally absorbed by the body.

Cryotherapy offers an alternative to surgical removal of the prostate (prostatectomy) or radiation therapy, particularly for men who may not be suitable candidates for these more invasive treatments. It's a targeted approach that aims to destroy cancerous tissue while minimizing damage to surrounding healthy tissue.

Key Facts:

• Minimally invasive.
• Freezes and destroys cancer cells.
• An alternative to surgery or radiation.
• Can be used for early-stage or recurrent prostate cancer.
• FDA-approved treatment.

Why is Cryotherapy for Prostate Cancer Performed?

Cryotherapy for prostate cancer is performed to eliminate cancerous cells within the prostate gland. Doctors may recommend it for several reasons:

• Primary Treatment for Early-Stage Prostate Cancer: When the cancer is confined to the prostate gland.
• Recurrent Cancer: When cancer returns after initial treatment like radiation therapy.
• Alternative for Unsuitable Surgical Candidates: For men who are not eligible for surgery due to age, other health conditions, or personal preference.
• Specific Cancer Characteristics: May be suitable for certain types of prostate cancer based on their aggressiveness and location.

When Doctors Recommend It:

Your doctor will consider several factors before recommending cryotherapy, including:

• Stage of the cancer: Is it localized or has it spread?
• Gleason score: A measure of the aggressiveness of the cancer cells.
• PSA level: Prostate-Specific Antigen levels in the blood, which can indicate the presence of cancer.
• Overall health: Your general physical condition and any other medical conditions you may have.
• Personal preference: Your wishes and concerns regarding treatment options.

Preparation for Cryotherapy for Prostate Cancer

Proper preparation is crucial for a successful cryotherapy procedure. Your doctor will provide specific instructions, but here's a general overview:

Essential Preparation Steps:

• Medical Evaluation: A thorough physical exam, blood tests, and imaging scans (MRI, ultrasound) to assess the extent of the cancer and your overall health.
• Medication Review: Inform your doctor about all medications, including prescription drugs, over-the-counter medications, and herbal supplements. Some medications, like blood thinners, may need to be stopped before the procedure.
• Bowel Preparation: You may be asked to cleanse your bowel with an enema or laxative before the procedure to reduce the risk of infection.
• Antibiotics: You will likely be prescribed antibiotics to prevent infection.
• Fasting: You will usually be asked to refrain from eating or drinking for a certain period (usually 6-8 hours) before the procedure.
• Shaving: The area around the perineum (between the anus and scrotum) will need to be shaved.

India-Specific Tips:

• Arrange for Transportation and Accommodation: Plan how you will get to and from the hospital, especially if you are traveling from another city. Arrange for accommodation if necessary.
• Gather Medical Records: Bring all relevant medical records, including previous test results, imaging scans, and doctor's notes.
• PCPNDT Act (Pre-Conception and Pre-Natal Diagnostic Techniques Act): While not directly related to cryotherapy, be aware of the regulations regarding sex determination in India. The hospital will likely have procedures in place to comply with the PCPNDT Act, and it's important to respect these regulations.
• Financial Planning: Understand the estimated cost of the procedure and any potential additional expenses. Discuss payment options and insurance coverage with the hospital.

What to Expect:

• On the day of the procedure, you will arrive at the hospital and be admitted.
• You will be asked to remove any jewelry or other objects that might interfere with the procedure.
• You will be asked to change into a hospital gown.
• An intravenous (IV) line will be inserted into your arm or hand to administer fluids and medications.
• You will be asked to empty your bladder.

The Cryotherapy for Prostate Cancer Procedure

The cryotherapy procedure typically takes 1-3 hours. Here's a step-by-step overview:

1. Anesthesia: You will receive either general anesthesia (you will be asleep) or spinal anesthesia (you will be numb from the waist down).
2. Positioning: You will be positioned on your back with your legs raised in stirrups.
3. Catheter Insertion: A warming catheter is placed in the urethra to protect it from freezing.
4. Cryoprobe Insertion: Using ultrasound or MRI guidance, the urologist will insert 4-6 thin cryoprobes through the skin of the perineum into the prostate gland.
5. Freezing: Argon gas is pumped through the cryoprobes, creating ice balls that freeze the prostate tissue and destroy the cancer cells. The temperature can reach as low as -40°C.
6. Monitoring: The urologist monitors the procedure using ultrasound or MRI to ensure accurate freezing of the targeted tissue while protecting surrounding structures like the rectum.
7. Thawing: After freezing, helium gas is passed through the cryoprobes to warm the tissue. This thawing process further damages the cancer cells. The freezing and thawing cycles may be repeated.
8. Cryoprobe Removal: The cryoprobes are removed.
9. Catheter Placement: A temporary urinary catheter is placed to drain urine from the bladder.

Duration: The procedure usually takes between 1 to 3 hours.

Comfort Level: With anesthesia, you will not feel any pain during the procedure. You may experience some discomfort or pressure after the procedure.

What Happens During the Procedure: The procedure is closely monitored by the urologist and a team of medical professionals. The aim is to precisely freeze and destroy the cancerous tissue while minimizing damage to surrounding healthy tissue.

Understanding Results

After cryotherapy, you will have follow-up appointments with your urologist to monitor your progress.

What Results Mean:

• Success: The goal of cryotherapy is to eliminate the cancer cells in the prostate gland. Follow-up biopsies are typically performed to confirm that the cancer has been eradicated. Studies have shown promising results, with a significant percentage of patients showing no evidence of clinically significant prostate cancer in follow-up biopsies. One study showed no clinically significant prostate cancer in 82% of patient biopsies.

• Possible Outcomes:

  • No Evidence of Cancer: Follow-up biopsies show no signs of cancer cells.
  • Cancer Recurrence: The cancer may return in the prostate gland.
  • Elevated PSA Levels: Rising PSA levels after treatment may indicate that the cancer has not been completely eradicated or has recurred.

Next Steps:

If the cryotherapy is successful, you will continue to have regular follow-up appointments with your urologist to monitor your PSA levels and overall health. If the cancer recurs or the PSA levels rise, further treatment may be necessary, such as radiation therapy, hormone therapy, or surgery.

Costs in India

The cost of cryotherapy for prostate cancer in India can vary significantly depending on several factors.

Price Range in ₹ (Tier-1, Tier-2 Cities):

• Tier-1 Cities (e.g., Mumbai, Delhi, Chennai, Bangalore): ₹2,50,000 to ₹5,00,000 or more.
• Tier-2 Cities: ₹2,00,000 to ₹4,00,000.

These are estimates and can vary significantly.

Government vs. Private:

• Government Hospitals: Cryotherapy may be available at a lower cost in government hospitals, but access and waiting times may be longer.
• Private Hospitals: Private hospitals generally offer more advanced technology and shorter waiting times but at a higher cost.

Insurance Tips:

• Check with your insurance provider to see if cryotherapy for prostate cancer is covered under your policy.
• Understand the terms and conditions of your insurance policy, including any deductibles, co-pays, and exclusions.
• Obtain pre-authorization from your insurance provider before undergoing the procedure.

How Ayu Helps

Ayu helps you manage your medical records effectively. Store your cryotherapy results digitally, track changes over time, and share your records securely with your doctor via QR code or direct sharing. This ensures you and your healthcare provider have easy access to essential information for informed decision-making.

FAQ

Q: Is cryotherapy a painful procedure?

A: You will not feel any pain during the procedure because you will be under anesthesia. You may experience some discomfort or pressure after the procedure.

Q: How long does it take to recover from cryotherapy?

A: Recovery time varies, but most men can return to their normal activities within a few weeks. You may experience some side effects, such as erectile dysfunction and urinary incontinence, which can take longer to resolve.

Q: What are the long-term side effects of cryotherapy?

A: The most common long-term side effects are erectile dysfunction and urinary incontinence. Other possible side effects include pain, swelling, and infection.

Q: How effective is cryotherapy for prostate cancer?

A: Cryotherapy can be an effective treatment for prostate cancer, particularly in early-stage cases. Studies have shown promising results, with a significant percentage of patients showing no evidence of cancer in follow-up biopsies.

Q: Who is a good candidate for cryotherapy?

A: Good candidates for cryotherapy are men with early-stage prostate cancer that is confined to the prostate gland, or men with recurrent cancer after initial treatment. It may also be an option for men who are not suitable candidates for surgery.

Q: What are the alternatives to cryotherapy?

A: Alternatives to cryotherapy include surgery (prostatectomy), radiation therapy, hormone therapy, and active surveillance.

Q: How do I find a doctor who performs cryotherapy in India?

A: You can search online directories, ask your primary care physician for a referral, or contact hospitals that specialize in cancer treatment. Fortis Healthcare Hospitals, Apollo Proton Cancer Centre, and Indraprastha Apollo Hospital are examples of hospitals in India offering cryotherapy.

Q: Is cryotherapy covered by insurance in India?

A: Coverage varies depending on your insurance provider and policy. Check with your insurance company to see if cryotherapy is covered under your policy.