Each hospital does things differently. We've included some general information about what might happen. Your doctor or nurse will give you more information about what will happen before, during and after your treatment.
Before your treatment
If your prostate is very large you may have hormone therapy for two to three months before you have cryotherapy. This can make the prostate smaller, and make the cancer easier to treat. As with all treatments, hormone therapy can cause side effects.
Your bowels need to be empty during cryotherapy so that your doctor can take clear scans of your prostate. So you might be given a laxative or an enema to empty your bowels before the treatment. An enema is a liquid that is put inside your back passage (rectum). You’ll also be asked not to eat for about six hours before the treatment, but will still be able to drink water up to four hours before the treatment.
During your treatment
Cryotherapy is usually done under general anaesthetic so that you’re asleep and won’t feel anything. If you can’t have a general anaesthetic for health reasons, you may be able to have a spinal (epidural) anaesthetic, so that you can’t feel anything in your lower body.
Your surgeon will pass a tube called a warming catheter up your penis and into your bladder. Warm liquid is passed through the catheter during the treatment so that your urethra (the tube you urinate through) and the wall of your back passage do not freeze.
The surgeon will place an ultrasound probe inside your back passage. This takes images of your prostate and displays them on a screen so your surgeon can see where to put the needles. They will then put several thin treatment needles through the skin between your testicles and back passage (perineum), and into your prostate.
Your surgeon will also put in some other thin needles to monitor the temperature in and around your prostate. This is to make sure the areas being treated reach the correct temperature, while the areas around your prostate, bowel and back passage do not freeze.
Freezing gases are passed down the treatment needles, causing the temperature to drop to about -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 of freezing and warming is usually carried out twice. The whole process takes about one to two hours.
The needles and probes are then removed, and the warming catheter is removed about 10 to 20 minutes later.
You’ll then have another tube put in to drain urine out of your bladder, either through your penis (urethral catheter) or through a small cut in your abdomen (suprapubic catheter). Some hospitals may put a suprapubic catheter in before treatment. Your catheter will be left in for a week or two.
After your treatment
Most people can go home the same day or the following day. It’s normal to have some pain or discomfort. Your doctor or nurse will tell you which pain-relieving drugs you can take.
You’ll be given antibiotics to take for a few days, to lower your risk of infection. Contact your doctor or nurse if you have any signs of a urine infection, such as:
- a high temperature (fever)
- feeling shivery
- a burning feeling when you urinate (pee)
- dark, cloudy or strong-smelling urine
- needing to urinate more often than usual.
You may be given drugs called alpha-blockers, such as tamsulosin or alfuzosin, to relax the muscle in and around your prostate to help you urinate. You may need to take them for a few weeks, or longer if you still have problems urinating. Alpha-blockers can cause side effects, so ask your doctor or nurse about these if you have any worries.
Cryotherapy usually causes the prostate to swell to begin with, which can make it difficult to urinate. You’ll go home with your catheter in place to drain urine from your bladder until the swelling has improved. Your urine will drain into a bag that you can empty. Or you might be offered a catheter valve instead of a bag. The valve fits on the end of the catheter tube and works like a tap. This means your urine will be stored in your bladder as usual. When you need to urinate, you can open the valve to empty your bladder. Your nurse will show you how to care for your catheter before you leave hospital.
Your catheter will usually be taken out at hospital one to two weeks after your cryotherapy treatment. This may feel uncomfortable. You’ll need to stay at the hospital for a few hours afterwards to check that you can urinate properly.
When the catheter is first removed, you may find that you leak urine. It’s a good idea to take spare underwear and trousers with you to the appointment. You can wear incontinence pads to absorb the urine – check if your hospital will provide these. If not, you can buy some at a pharmacy and take them with you to the appointment.
You may see some blood in your urine while the catheter is in place, and immediately after it’s taken out. 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.
You might have some bruising and swelling around your testicles, buttocks and inner thighs for a few days after treatment. This can be worrying but is normal and will pass. It may help to wear tighter underwear for support. Holding an ice pack against the bruised and swollen area for 10 minutes every hour may help to reduce the swelling.
Your doctor or nurse may advise you not to stand for long periods of time for the first few weeks, as this can cause the prostate to swell more. 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, including regular PSA tests. The PSA test is a blood test that measures the amount of a protein called prostate specific antigen (PSA) in your blood. It’s a good way to check how well the cryotherapy has worked. You may also have an MRI scan after treatment to check all your cancer has been treated.
How often you have check-ups will depend on your hospital, but you should have a PSA test about every three to six 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.
After cryotherapy, your PSA level should fall and then stay low. A continuous rise in your PSA level could be a sign that your cancer has come back. If this happens, your doctor may suggest you have further tests, such as an MRI scan or a prostate biopsy, to find out if it has.
If your cancer has come back, your doctor will talk to you about further treatment options. If cryotherapy was your first treatment, you may be offered more cryotherapy. Or they may offer radiotherapy or surgery. If you had cryotherapy as a second treatment following radiotherapy, you may be offered hormone therapy.