Salvage Cryoablation of the Prostate

What is salvage prostate cryoablation?

Salvage cryoablation of the prostate is a procedure recommended for prostate cancer that has returned in men who have been treated previously.

Salvage literally means “save.” The doctor is trying to save the patient from the cancer. The procedure uses cryoablation, or extreme cold, to freeze the prostate, so that the cancer cells within it will freeze and die. It is also called cryosurgery or cryotherapy.

The procedure is typically done on an outpatient basis and is minimally invasive.

What is the purpose of the prostate and where is it found in your body?

The prostate is part of the male reproductive system. Its main purpose is to produce fluid for semen, the milky fluid in which sperm swims. During an orgasm, the prostate’s muscles tighten to push the semen out of the penis.

The prostate is a gland about the size of a walnut that is under the bladder and in front of the rectum, or the lower end of the bowel. The urethra, or the thin tube that runs the length of the penis and carries both urine and semen out of the body, goes through the prostate.

When is salvage prostate cryoablation recommended?

Salvage prostate cryoablation is mostly used in men who have already been treated with radiation for early-stage prostate cancer.

Each patient is different, and many factors are considered when looking at different treatment options. Before your healthcare provider recommends this treatment, they will consider these factors:

• Stage of the cancer, or how much the cancer has grown and spread at the time it is diagnosed.
• Aggressiveness, or how quickly the cancer is spreading.
• Your age and life expectancy.
• Your physical and sexual activity level.

• Whether you have any other medical issues.

What is the difference between salvage cryoablation of the prostate and other treatment options for prostate cancer?

Salvage prostate cryoablation, when used on the whole gland, destroys all of the prostate tissue. Other treatments do the following:

• Radiation therapykills the individual cells. The more aggressive the cancer, the harder the cells are to kill with radiation.
• Radical prostatectomy, or surgery to remove the entire prostate and some of the surrounding tissue, is sometimes done after failed radiation therapy. It has a risk of significant complications, such as incontinence and erectile dysfunction.
• Hormonal therapy, to reduce the level of male hormones, is another option and may be recommended to reduce tumor size and slow the cancer growth. It will not cure the cancer and has significant side effects.

What happens during the salvage cryoablation of the prostate procedure?

Cryoablation of the prostate exposes the entire prostate gland to a temperature of -40° C or lower in order to kill cancer cells. The procedure pinpoints the prostate while avoiding the surrounding body parts, such as the rectum, in order to minimize damage to those other parts.

The procedure is done under general anesthesia, so you will be asleep.

The doctor inserts several cryoprobes, or thin, hollow needles, though the perineum (the skin between the scrotum and the rectum) and into the prostate. To guide the needles to the prostate, the doctor watches an ultrasound, equipment that projects a picture of the inside of the body onto a screen. The needles carry argon gas, a freezing agent to the prostate. When the needles reach the prostate, the gas is released and freezes and kills the prostate cells and any tumors within the area.

What happens after the salvage cryoablation of the prostate procedure?

At the end of the salvage prostate cryoablation surgery, when the ice thaws, the prostate tissue turns into a scar and the cancer should be dead.

What can you expect after a cryoablation of the prostate?

After the procedure, your doctor will insert a catheter, or a drainage tube, to help urine leave the body. This is because it’s usual for the prostate to be swollen for about seven days, making it hard for you to urinate. Your healthcare provider will remove the catheter at an office visit about seven days after the procedure. Then you will be able to urinate on your own.

What are the benefits of salvage prostate cryoablation?

One benefit of salvage cryoablation of the prostate is that it is a minimally invasive procedure. Many times it does not require a hospital stay. Everyone is different, but you will probably be able to resume normal activity within the first week following the procedure.

Other benefits include:

• Favorable success rate.
• Low complication rate.
• High quality of life.
• Short recovery period.
• Minimal anesthesia.

Salvage cryoablation of the prostate offers another treatment option to men who have failed radiation treatment. In addition, it can be repeated if the first treatment did not completely kill the cancer.

What are the complications of salvage prostate cryoablation?

Recent medical and technical advances have shown a steady decline of side effects from salvage prostate cryoablation. As it is a “salvage” procedure and a last chance to get rid of the cancer for many men, it is somewhat common that you might have problems with erectile dysfunction, or not being able to keep an erection during sex. This can be treated with medication. Otherwise, side effects are very rare (including the risk for urine leakage, which is under 3%).

You might experience these types of complications:

• Swelling of the scrotum.
• Pain or burning when urinating.
• Blood in the urine.
• Urinary urgency and increased urinary frequency.
• Pelvic or rectal pain.

Rarely, the procedure may also risk injury to surrounding tissues such as the rectum or bladder because of the nearby location of these structures.

Another rare complication is the potential for the patient to develop a fistula, an abnormal opening that connects the urethra and the rectum. The fistula may cause the patient to have diarrhea from urine in the rectum. It may also cause infection from bacteria in the bladder.

What is the follow-up treatment after salvage cryoablation of the prostate?

After three months, you will have a follow-up visit with your healthcare provider. At this time, you’ll have a PSA test, a blood test that checks for prostate-specific antigen, or PSA, a protein produced by the prostate gland. The PSA test is done to make sure that the treatment worked.

Your healthcare provider will monitor you and suggest a follow-up plan depending on the stage of the cancer and the potential for it to return.

A note from Cleveland Clinic

If you’ve been treated for prostate cancer and it has come back, your healthcare provider might suggest that you have a salvage cryoablation. It’s important to have an honest discussion of the risks and benefits of the procedure and a good understanding of what to expect. Please make sure to ask questions about whatever concerns you. The goal is for you to be able to live longer and live well.