Cryosurgery uses liquid nitrogen to freeze and kill prostate cancer cells. Guided by TRUS, the doctor places needles in preselected locations in the prostate gland. The needle tracks are dilated for the thin metal cryo probes to be inserted through the skin of the perineum into the prostate. Liquid nitrogen in the cryo probes forms an ice ball that freezes the prostate cancer cells; as the cells thaw, they rupture. The procedure takes about two hours, requires anesthesia (either general or spinal), and requires one to two days in the hospital.
During cryosurgery, a warming catheter inserted through the penis protects the urethra, and incontinence is seldom a problem. However, the overlying nerve bundles usually freeze, so most men become impotent.
The appearance of prostate tissue in ultrasound images changes when it is frozen. To be sure enough prostate tissue is destroyed without too much damage to nearby tissues, the surgeon carefully watches these images during the procedure. A suprapubic catheter is placed through a skin incision on the abdomen into the bladder so that if the prostate swells after the procedure (which usually occurs), it won't block the passage of urine. The catheter is removed one to two weeks later.
After the procedure, there will be some bruising and soreness of the area where the probe was inserted. You will likely stay in the hospital for one or two days. Cryosurgery is less invasive than radical prostatectomy, so there is less blood loss, a shorter hospital stay, shorter recovery period, and less pain than radical surgery. But compared with surgery or radiation therapy, doctors know much less about the long-term effectiveness of cryosurgery.
Current techniques using ultrasound guidance and precise temperature monitoring have only been available for a few years. Outcomes of long-term (10- to 15-year) follow-up must still be collected and analyzed. For this reason, most doctors do not include cryotherapy among the options they routinely consider for initial treatment of prostate cancer.