28 Sep Prostate:Cryotherapy

Well today I am going to be explaining what Cryotherapy, Cryosurgery, or Cryoablation is and what it does for prostate cancer. This procedure can be referred to as all of the following, but for the purpose of my writing, I am going to just refer to it as cryosurgery. So cryosurgery simply means the application of extreme cold to destroy diseased tissue, in this case, prostate cancer.
Physicians have been using this technology since the 1960’s. In the use of prostate cancer, it was highly regarded for a short period of time in the 90’s, but then was backed off due to the lack of evidence and the improvement of robotic surgical techniques and radiation therapy. Along with those improvements in the 90’s and into the 21st century, also came huge improvements in imaging capabilities. Since imaging improved, it allowed physicians to see where the prostate cancer was located more precisely, and thus improving their ability to deliver extreme cold temperatures to only the affected prostate cancer cells and not the normal tissues.
So what does the equipment look like?
   Cryotherapy is carried out by using a cryoprobe, a thin wand like device with a trigger and handle, or a small series of needles, attached to a source of nitrogen with tubing, that super cools the tip. All units have to be approved by the FDA for use in oncology procedures and undergo numerous testing and trials. The cryoprobe is then placed in the proper position using Ultra Sound Guidance(US). As the internal tissues are being froze, the physician is then able to avoid normal tissues by viewing the position of the probe with Ultra Sound, CT, or MRI images that are then transmitted onto a small screen to view. In the above picture, this is a system with needles(probes) and it uses Ultra Sound, which is the most commonly used device.
Hows does this work?
Simply put, the prostate and the cancer cells within the prostate are frozen to a temperature of -40 degree Fahrenheit or lower.  Cells being directly exposed to these extreme temperatures will form ice crystals inside of them, and they will then physically tear apart. Another way in which cryosurgery works is by shrinking and swelling of the prostate cancer cells. As ice forms in one portion of the cell, it draws water from surrounding cells to fill that void, causing it to swell. The cells that gave up the water have now shrunk. As the cell begins to thaw, it gives up water to the cell it borrowed it from…causing the cell that shrunk to swell up and burst, and the cell that thawed to shrink and die as well. The final way in which Cryosurgery works is by killing off the blood supply. As ice forms within the cell, ice also forms inside of the small blood vessels that supply the cancer cells and promote them to grow. Since this ice cuts off the blood supply in the vessel, it then cuts the nutrients and food that the cancer cells need in order to survive and thus die.
How is the procedure performed?
     As you can see in this illustration, there is an UltraSound probe that is inserted into the rectum. This allows the physicians to see where the prostate is located inside the patient. Once the prostate is located inside of the patient, a needle or probe is then placed through the perineum (area located between the rectum and the scrotum) and directly into the prostate. Once the probe is in the proper position, then the nitrogen is administered in “pulses” (turning it on and off to give different amounts at varying times) and the probe is then inserted to different depths with in the prostate. This helps to ensure that all of the cancer inside of the prostate is covered and nothing is missed. Other probes can be inserted at the same time, or after one is pulled out, it just depends on technique and preference of the surgeon doing the procedure. Patients can have the option to have this done as an outpatient surgery and given general anesthetic to be completely asleep during the procedure. Other patients may choose the option of being awake and having it done n the physicians office. If this is the case, a local anesthetic will be placed on the perineum. Patients may feel a tingling or a pinching when the nitrogen is being administered, this feels much like a shot of Novocaine in a dental procedure.
Risks:

• Usually requires a short hospital stay.
• May cause permanent impotence since nerves controlling sexual potency are commonly involved in the freezing process. However, nerves can regenerate, resolving the problem in some patients.
• While the patient is under anesthesia, a bladder tube is positioned to drain urine until the swelling of the bladder neck—as a result of the procedure—resolves.
• May cause urethral sloughing; that is, blocking of the urine stream with dead tissue. Sloughing is reduced by keeping the urethra warm with sterile water circulating continuously through a catheter placed in the urethra during the procedure.

 If you or a loved one have been diagnosed with cancer, and you need help or have questions relating to other topics besides the one in this topic, please feel free to contact me. As always, if you have any other questions or concerns, please feel free to contact me directly at: CANCERGEEK@GMAIL.COM or CANCERGEEK@CANCERGEEK.COM
~CancerGeek