Cryosurgery treats localized prostate cancer by freezing and destroying the prostate. There is renewed interest in this procedure due to improved technology, and the fact that the Health Care Financing Administration (HCFA) has authorized reimbursement for the procedure in men with newly diagnosed T1-T3 stage prostate cancer as of July 1, 1999. HCFA made this decision because 5-year follow-up results with cryosurgery appear to be the same as those of radiation treatment. Cryosurgery is currently being investigated for use following radiation. One of the main side effects appears to be incontinence. A five-pronged probe filled with nitrogen is guided through a skin incision into the cancer using transrectal ultrasound (TRUS). TRUS allows your physician to monitor the freezing process of the prostate, which can get as low as -195° Celsius. A warming catheter is placed in the urethra to prevent damage. Cryosurgery has several benefits: low morbidity, minimal blood loss, and a short hospital stay. Complications such as impotence and incontinence can arise if the freezing damages nerves near the prostate. Some patients may also experience penile numbness or swelling, or develop obstructions from dead prostate tissue.
High Intensity Focused Ultrasound (HIFU)
HIFU is a new treatment that has recently obtained FDA approval in the United States so it is not widely available yet. If your local hospital does not yet offer this procedure, it may still be possible to enter clinical trials of HIFU.
HIFU works by destroying tissue with rapid heat pulses that focus on the cancer that has not yet spread to other parts of the body. The procedure involves using a transrectal ultrasound probe to aim sound waves on the prostate tumor. The cancer cells are then heated to a very high temperature so they will die. The entire procedure takes about two hours and the patient needs to have a urinary catheter in place for about two weeks following the procedure. Side effects of this focal therapy include further urinary or sexual problems such as urinary stricture, erectile dysfunction, and urgency.