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Cryotherapy

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Cryotherapy is a treatment that uses extreme cold to freeze and destroy cancer cells. It is also known as cryosurgery or cryoablation. Thin needles are inserted into the prostate and a gas is passed down them to freeze the prostate and kill the cancer cells.

You may be able to have cryotherapy if your cancer is contained inside your prostate (localised prostate cancer). And it can sometimes be an option if your prostate cancer is just breaking through your prostate but hasn't spread to the surrounding area (locally advanced prostate cancer).

Cryotherapy may be a treatment option for men whose prostate cancer has come back after treatment with radiotherapy or brachytherapy. But you may also be able to have it as a first treatment. You may not be suitable for cryotherapy if you have severe urinary problems as it can make these worse.

Cryotherapy is newer than some of the other treatments for prostate cancer. We don't know much about how well it works in the long term, including the risk of side effects. This means it is only available in specialist centres in the UK, or as part of a clinical trial.

On this page

  • Types of cryotherapy
  • What are the advantages and disadvantages?
  • What does cryotherapy involve?
  • What happens afterwards?
  • What are the side effects?
  • What is focal cryotherapy?
  • Dealing with prostate cancer
  • Questions to ask your doctor or nurse
  • More information

 Listen to a summary of this page 

Types of cryotherapy

There are two types of cryotherapy.

  • Whole-prostate cryotherapy freezes the whole prostate including healthy tissue.
  • Focal cryotherapy freezes only the areas of the prostate where the cancer is. This means less healthy tissue is frozen compared to whole-prostate cryotherapy.

Focal cryotherapy isn’t as widely available in the UK as whole-prostate cryotherapy. So when we talk about cryotherapy, we’re referring to whole-prostate cryotherapy.

In the UK cryotherapy is only available in specialist centres or as part of a clinical trial. This is because it is newer than some other treatments, and we don’t know as much about how well it works in the long term, including the risk of side effects. Read more about clinical trials.

Other treatment options

Other treatment options for localised prostate cancer include:

You may also be offered high intensity focused ultrasound (HIFU). Like cryotherapy, HIFU might only be available in specialist centres or as part of a clinical trial.

What are the advantages and disadvantages?

An advantagefor one person might not be for someone else. Speak to your doctor or nurse before deciding about the pros and cons or cryotherapy and other treatments. There is a list of questions further down that you might find helpful.

Advantages

  • Cryotherapy involves less invasive surgery than some other treatments, with little blood loss.
  • You will only be in hospital for a short time and recovery time is quick.
  • It may be a treatment option if your cancer has come back after radiotherapy or brachytherapy.

Disadvantages

  • You may get side effects that might affect your daily life, such as erection and urinary problems
  • We do not know as much about how well cryotherapy treats prostate cancer or the side effects in the long term (after 10 or 15 years), compared with other treatments.
  • Cryotherapy is not widely available in the UK.

What does cryotherapy involve?

Each hospital does things differently. Ask your doctor or nurse how they carry out the treatment.

  • Before having treatment  

    You will need to take a laxative or have an enema to help empty your bowels before the treatment. This will help your doctor take clear scans of your prostate during the treatment.

  • During treatment  

    Cryotherapy usually takes about two hours and is done under either general anaesthetic so that you're asleep and won't feel anything.  It's sometimes done under spinal anaesthetic (an epidural), so you're awake but won't feel anything.

    A thin tube called a catheter is passed into your bladder through your urethra (the tube that you urinate through). Warm liquid is passed through the catheter during the treatment to help stop your urethra and the wall of your back passage (rectum) being frozen.

    An ultrasound probe is inserted into your back passage. This scans your prostate and an image appears on a screen. This helps your doctor to see where to insert the needles. Several thin needles are then inserted into your prostate through the skin between your testicles and back passage (perineum).

    Freezing gases are passed down the needles, causing the temperature to drop to about minus 40°C. This freezes and destroys the prostate tissue. Your prostate is then allowed to warm up, either naturally or by passing a different gas through the needles to warm it. This process is usually carried out twice.

    The needles and probes are then removed. After about 20 minutes the warming catheter is also removed.

  • After treatment  

    Most people can go home on the same day or the following day. It's normal to have some pain or discomfort and your doctor or nurse will tell you which pain-relieving drugs you can take.

    You'll be given antibiotics to lower your risk of infection.

    You should take these for a few days. Contact your doctor or nurse if you have any signs of a urine infection, such as:

    • a high temperature
    • a burning sensation when you urinate
    • dark, cloudy or unpleasant smelling urine
    • needing to urinate more often than usual.

    You may be given drugs called alpha-blockers, such as tamsulosin, to relax the muscle in and around your prostate to help you urinate. You may take tamsulosin for a few weeks after treatment or for longer if you still have problems urinating. Tamsulosin may cause side effects, so talk to your doctor or nurse about this.

    Catheter

    You will go home with a catheter in place to avoid any problems urinating. This will stay in for one to two weeks. your nurse will show you how to care for your catheter before you leave the hospital.

    When the catheter is removed, you may find that you leak urine. It’s a good idea to take spare underwear and a spare pair of trousers with you. You can wear incontinence pads to help absorb urine – check if your hospital will provide these. If they don’t it’s a good idea to take your own. You can buy them at pharmacies.

    You may see some blood in your urine while you have your catheter in and immediately after it’s removed. This is normal. Drink plenty of fluids to help clear the blood. If you see signs of infection or lots of blood clots in your urine speak to your doctor or nurse.

    Swelling

    You might have some bruising and swelling around your testicles (scrotum), buttocks and inner thigh for a few days after treatment. This is normal and will pass. It may help to wear tighter fitting underwear to help provide support. Your doctor or nurse may advise you not to stand for long periods of time for the first few weeks. You should be able to go back to your day-to-day activities as soon as you feel able to. But it may take a few weeks or months before you feel back to normal.

  • What happens afterwards?  

    You will have check-ups with your doctor or nurse at the hospital. You will have regular PSA tests to check how well the cryotherapy has worked. How often you have these will depend on your hospital, but you should have a PSA test about every three months for at least the first year, and every six months after that. Ask your doctor or nurse how often you’ll have PSA tests. If your PSA level rises this could be a sign that your cancer has come back. You may also have an MRI scan after treatment to check all your prostate cancer has been treated. Read more about what to expect at follow-up appointments.

    If tests show that your cancer has started to grow again (recurrent prostate cancer), and you had cryotherapy as a first treatment, you may be able to have more cryotherapy. Or you may be offered radiotherapy or, rarely, surgery. If you had cryotherapy as a second treatment and your cancer starts to grow again, you may be offered hormone therapy.

What are the side effects?

Like all treatments, cryotherapy can cause side effects. These will affect each man differently and you may not get all of them.

Many of the side effects of cryotherapy are caused by healthy tissues being frozen and damaged. You are more likely to get side effects if you have already had radiotherapy or brachytherapy to your prostate. This is because they might have already damaged the tissues around your prostate. The most common side effects of cryotherapy are erection and urinary problems.

  • Erection problems  

    The most common long-term side effect of cryotherapy is difficulty getting or keeping an erection (erectile dysfunction) because the nerves that control erections can be damaged. More than three quarters of men (over 75 per cent) can’t get an erection after cryotherapy.

    Some men may find that they gradually get their erections back. And there are treatments that can help.

  • Urinary problems  

    Cryotherapy can cause urinary problems such as leaking urine (urinary incontinence) and difficulty urinating. Most men have some urinary problems for the first three to four weeks after cryotherapy. For some men, these problems gradually improve after a few months. But for others it can be a long-term problem.

    Leaking urine after cryotherapy is more likely if you have cryotherapy as a second treatment. Leaking urine may improve with time but for some men the problem will be long term. There are ways to manage leaking urine.

    Damage to your urethra during cryotherapy can cause it to narrow. This can cause problems urinating, including a weak or slow flow of urine or problems emptying your bladder (urine retention). This is more likely if you have cryotherapy as a second treatment. Urine retention can lead to urine infections or painful bladder stones. If it’s not treated, it can damage your kidneys. There are treatments that can help, including using a catheter, medicines or surgery.

  • Pain  

    It’s normal to have some pain after having cryotherapy. Some men will have pain that lasts for a few weeks or months. It may be in the area in or around your penis, testicles and back passage. You’re more likely to get pain if you’ve had another treatment before cryotherapy. Pain usually improves, and pain-relieving drugs can help. Your doctor or nurse can tell you which ones you can take.

  • Bowel problems  

    If you have cryotherapy after radiotherapy, there is a very small chance you may get a complication where a hole forms between your back passage and your urethra. This is called a fistula. Fistulas can develop up to several weeks after treatment. Signs include:

    • pain
    • infection
    • frequent loose watery bowel movements (diarrhoea)
    • discharge from your urethra or back passage.

    If you have any of these, contact your doctor or nurse. If you develop a fistula, you may need to have an operation to repair the hole.

  • Problems having children  

    You may not be able to have children naturally after cryotherapy. Cryotherapy can damage the prostate, which makes the fluid that carries sperm. If you’re planning to have children, you may be able to store your sperm before cryotherapy. If this is important to you ask your doctor or nurse about it.

What is focal cryotherapy

Focal cryotherapy is a new way of treating prostate cancer. It’s not widely available in the UK but there are some hospitals that offer it.

It isn’t suitable for all men and will depend on the size and position of your cancer. Speak to your doctor or nurse about whether it may be an option.

What does focal cryotherapy involve?

Focal cryotherapy is done in a similar way to whole-prostate cryotherapy but it uses fewer needles, which are only inserted into the cancer rather than the whole prostate.

What are the side effects?

Focal cryotherapy can cause the same side effects as whole-prostate cryotherapy. But research suggests that you may be less likely to get these side effects with focal cryotherapy and they may be less severe because less healthy prostate tissue is damaged.

Dealing with prostate cancer

Being diagnosed with prostate cancer can change how you feel about life. If you’re dealing with prostate cancer you may feel scared, stressed or even angry. There is no ‘right’ way to feel and everyone reacts differently. There are things you can do to help yourself and people who can help.

Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What is the risk of side effects and how can they be managed?
  • What are my other treatment options?
  • How much experience does the specialist have in carrying out cryotherapy?
  • How often will you check my PSA after the treatment?

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References

Updated: Jul 2014 | Due for Review: Jul 2016

  • Full list of references used to produce this page  

    1. Shelley M, Wilt T, Coles B, Mason M. Cryotherapy for localised prostate cancer (Review). The Cochrane Library. 2008, Issue 4.
    2. Heidenreich A, Bolla M, Joniau S, Mason M.D, Matveev V, Mottet N, T.H. Schmid H-P, van der Kwast T.H, Wiegel T, Zattoni F. Guidelines on Prostate Cancer. European Association of Urology 2012
    3. National Institute for Clinical Excellence. Prostate cancer: diagnosis and treatment. Full Guideline 2008
    4. BUG, BAUS and BPG, MDT (Multi-disciplinary Team) Guidance for Managing Prostate Cancer, 2nd Edition, November 2009
    5. National Institute for Clinical Excellence. Cryotherapy for recurrent prostate cancer. Interventional procedure guidance 119. 2005
    6. Cytron S, Greene D, Witzsch U, Nylund P, Bjerklunc Johansen TE. Cryoablation of the prostate: technical recommendations. Prostate Cancer and Prostatic Diseases 2009; 12: 339-346.
    7. Gowardhan B. Thomas B. Asterling S. Sheikh N. Greene D. Cryosurgery for prostate cancer-experience with third generation cryosurgery and novel developments in the field. European Urology Supplements. 2007; 6(8): 516-520.
    8. Kimura M. Mouraviev V. Tsivian M. Mayes JM. Satoh T. Polascik TJ. Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy. [Review] BJU International. 2009; 105(2):191-201
    9. Levy D. Avallone A. Jones JS. Current state of urological cryosurgery: prostate and kidney. [Review] BJU International. 2010; 105(5):590-600
    10. Mouraviev V, Spiess PE, Jones JS. Salvage cryoablation for locally recurrent prostate cancer following primary radiotherapy. Eur Urol. 2012; 61(6):1204-11.

Personal stories

Mick Granger's story

Mick has been undergoing cryotherapy as part of a trial at University College London Hospital. He shares his experience of the treatment so far.

Read Mick's story