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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Practice pelvic floor exercises, and keep doing them even after your surgery. These exercises squeeze your pelvic floor muscles and help them become stronger. Ask your caregiver for more information about pelvic floor exercises.
  
  
• You may be asked to stop smoking. Ask your caregiver for more information if you have trouble stopping smoking.
  
  
• You may need to have blood and urine tests, a transrectal ultrasound, cystoscopy, or prostate biopsy. You may also need other tests, such as a bone scan, chest x-ray, or an electrocardiogram (ECG). Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• You may need to stop driving, lifting heavy things, having sexual intercourse (sex), or doing strenuous or tiring activities.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• You may need to take medicines such as magnesium citrate. These medicines are needed to help empty and clean out your bowel before the surgery.
  
  
• You may be given a pill to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You may need to use a liquid medicine called enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your surgery, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You will be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved onto a special bed. Caregivers may give a regional or general anesthesia to keep you numb or completely asleep. Your abdomen and genital area will be cleaned with soap and water. Sheets will be put over you to keep the surgery area clean. Caregivers will help you put your legs up in stirrups (leg holders). The bladder will be washed with saline (salt water) to help distend (expand) the abdominal area.
  
  
• A warming catheter (tube) will be placed in your urethra. This will help protect the urethra and rectum from getting frozen by the cold temperature. Caregivers will 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 will be used. Six to thirty cryoprobes will be placed into the prostate through your perineum. These cryoprobes are connected to a special machine and computer where your caregiver can control the temperature. Sensors will also be placed to monitor the temperature of the prostate and the structures around it. A cryogen, such as nitrogen or argon, will be 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 will make small ice balls and freeze the cancer cells. Your caregiver will then allow the ice to thaw (melt) by replacing the liquid with another chemical called helium. This whole process will damage and kill 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 will be put into your bladder to help drain your urine. The cryoprobes will be removed and incisions, if made, will be 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You cannot urinate, or if you have a catheter, no urine is filling the bag.
  
  
• You have new symptoms since the last time you saw your caregiver.
  
  
• You have pain that does not go away even after taking pain medicines.
  
  
• Your symptoms are getting worse.
  
  
• Your urine becomes red, very cloudy, and foul (bad) smelling.

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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.