Cryosurgery For Prostate Cancer

WHAT YOU SHOULD KNOW:

• Cryosurgery (kri-o-SER-jer-e), also called cryotherapy (kri-o-THER-ah-pe) or cryoablation, is surgery to treat prostate cancer (tumor) by freezing the prostate cancer cells. The prostate is a male sex gland that helps make semen. It wraps around the urethra and the neck of the bladder. The urethra is a tube that carries urine from the bladder to the end of the penis. With prostate cancer, tumor cells become cancerous and divide without control or order. These cancer cells often make too much tissue and affect other nearby structures in the prostate.
  
  
• In cryosurgery, different types of cryoprobes (special probes or needles) may be inserted in the perineum. The perineum is the area between your penis and rectum (rear end). These probes are passed with cryogen (freezing liquid chemical) to damage and kill the cancer cells. Cryosurgery is done using ultrasound with a probe placed in the rectum as a guide. As cryogen fills the prostate, small ice balls are formed to freeze the cancer cells. Sometimes, hormone or radiation therapy may be used a few months before cryosurgery to shrink a large tumor. You and your caregiver will decide if cryosurgery for your prostate cancer is right for you. With cryosurgery, your prostate cancer may be treated and the symptoms it causes relieved.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Problems may happen during your cryosurgery that may lead to an open prostate surgery. Since the temperature will be so cold, it may cause irritation or damage in and around the prostate. Your prostate or other parts of the urinary tract may get injured during surgery. There is also a danger that a blood or nerve supply may be affected. This may cause you to have more problems passing urine or having an erection. You may also have swelling, pelvic pain, or a numb feeling down to your legs. Even after having cryosurgery, there is a chance that your tumor may recur (come back) or not be completely removed. You may need to have more cryosurgeries or other procedures later on.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Without treatment, your prostate cancer may continue to grow and push on other structures near it. You may develop more bowel, sex, or urinary problems. Your cancer may also metastasize (spread) to other parts of your body. Once cancer spreads, it becomes more difficult to treat and other serious problems may develop. This may lead to more serious and often life-threatening problems, such as heart, liver, or brain damage. Ask your caregiver if you are worried or have questions about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Anesthesia: This is medicine to make you comfortable during the surgery. Caregivers work with you to decide which anesthesia is best for you.
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Regional anesthesia: Caregivers give this medicine to make you numb or not feel pain during or after a surgery. It works by blocking a nerve that supplies a particular part of your body. With regional anesthesia, you remain awake or may become a little drowsy. This allows your caregiver to talk to you during the surgery if needed.

During your surgery:

• Your abdomen and genital area are cleaned with soap and water. Sheets are put over you to keep the surgery area clean. Caregivers may put your legs up in stirrups (leg holders). The bladder is irrigated (washed out) with saline (salt water). This keeps the abdomen distended (expanded) and the organs away from the freezing area.
  
  
• A warming catheter (tube) is placed in your urethra. This helps protect the urethra and rectum from getting frozen by the cold temperature. Caregivers put an ultrasound probe into your rectum to guide the insertion of the cryoprobes. Small incisions (cuts) may be made in your perineum if large cryoprobes are used. Six to thirty cryoprobes may be directly placed into the prostate through your perineum. These cryoprobes are connected to a special machine and computer so your caregiver may control the temperature. Sensors are also placed to monitor the temperature of the prostate and the structures around it. A cryogen, such as nitrogen or argon, is then passed into the cryoprobes until it fills the prostate.
  
  
• Once the cryogen is inside the prostate, your caregiver may set the temperature to the freezing point or lower. This forms small ice balls and freezes the cancer cells. Your caregiver may then allow the ice to thaw (melt) by replacing the liquid with another chemical called helium. This whole process damages and kills the prostate cancer cells. He may repeat the freezing and thawing process to make sure all the cancer cells are killed. When the last thawing is completed, a catheter is inserted into your bladder to help drain your urine. The cryoprobes are removed and incisions, if made, are sewn and covered with bandages.

After your surgery:

You may be taken to a recovery room until you are awake. Caregivers watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you may be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your perineum. The catheter inserted in your bladder may be left there for 1 to 3 weeks to drain your urine. Ask your caregiver for information on how to take care of your catheter.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Hormone medicines: These medicines are needed to block the male hormones such as testosterones that make the tumor bigger. Hormone medicines help shrink the tumor and prevent further problems. Ask your caregiver for more information about these medicines.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.