What is cryotherapy?
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Treatments

Cryotherapy

What is cryotherapy?

Cryotherapy is a treatment that uses extreme cold to freeze and destroy cancer cells. It is also called cryosurgery or cryoablation. During the treatment, thin needles are put into the prostate and a gas is passed through them to freeze and kill the cancer cells.

It is newer than other treatments, so we still need to know more about the side effects and how well it works in the long term. This is why you can only have cryotherapy as part of a clinical trial or at a specialist centre. Some private clinics do it too, but you would have to pay for it yourself, or through your health insurance if you have one.

Types of cryotherapy

There are two types of cryotherapy.

  • Focal cryotherapy. This only treats the area in the prostate where there is cancer. It means that less healthy tissue is damaged than in whole-prostate cryotherapy. You may also hear this called focal therapy or partial ablation with cryotherapy. Focal cryotherapy is the most common type of cryotherapy treatment.

focal cryotherapy

  • Whole-prostate cryotherapy. This treats the whole prostate, which means that both the cancer cells and healthy prostate tissue are damaged. It is sometimes offered when the cancer has spread to several different areas in the prostate. You may also hear this called whole-gland treatment. Whole-prostate cryotherapy is not offered very often.

Whole gland cryotherapy

Who can have cryotherapy?

Your prostate cancer needs to be the right stage and grade to have cryotherapy. You will have an MRI scan to find this out. You might also need another biopsy before your doctor can offer cryotherapy. The doctor will also ask you which side effects you’re most worried about, to help you decide if cryotherapy is right for you.

Cryotherapy is usually offered to men whose cancer has not spread outside the prostate (localised prostate cancer) and is in Cambridge Prognostic Group (CPG) 1 to 3 (low to medium risk of spreading). It is not usually offered to men whose cancer has a high risk of spreading (CPG 4 and 5) because more research is needed to know how well it works. Some studies have shown that it may slow the growth of high-risk prostate cancer, but others have not.

Cryotherapy might be offered if your cancer has just started to break out of the prostate (locally advanced prostate cancer), but this is less common.  

It is also offered to some men whose prostate cancer has come back after previous treatment.

Cryotherapy is not currently available to men with advanced prostate cancer. We are waiting for the results from a clinical trial to see if cryotherapy may be a good treatment option for people with advanced prostate cancer.

Other treatment options

The stage and grade of your prostate cancer helps your doctor to decide which treatment you may need. Read more about the treatment options for localised prostate cancer, locally advanced prostate cancer and advanced prostate cancer.

Can I have cryotherapy if I’ve already had treatment?

Cryotherapy can be used to treat prostate cancer that has come back after previous radiotherapy (recurrent prostate cancer). This is called salvage cryotherapy.

And if your cancer comes back after your first cryotherapy treatment, you may be offered another session. You may hear this called redo or repeat cryotherapy.

What are the advantages and disadvantages?

Take time to decide if cryotherapy is right for you. Talk through the advantages and disadvantages with your doctor or nurse. Or you can call our Specialist Nurses.

We’ve included a list of questions to ask your doctor, which you might find helpful.  

Advantages

  • Both focal and whole-prostate cryotherapy are less invasive than other treatments, and are not considered major surgery. If you can’t have surgery because you aren’t well enough or have other health problems, then cryotherapy might be suitable.
  • You should only be in the hospital for up to 24 hours.
  • Recovery time is usually short – most men return to their normal activities within a few weeks.
  • You can avoid some of the more severe side effects of other treatments that can impact day-to-day life. For example, the urinary side effects of cryotherapy may be less severe. But cryotherapy does have side effects, and some are worse than others.
  • You can have cryotherapy again if your cancer comes back. This isn’t the case for all treatments.

Disadvantages

  • At the moment, cryotherapy isn’t widely available in the UK. However, it is likely that more centres will offer focal treatments for prostate cancer in future. Ask your doctor about this.
  • You might get side effects, such as  erection and urinary problems.
  • Cryotherapy can affect your ability to have children (fertility). If you want to have children, speak to your doctor about storing your sperm in a sperm bank before having the treatment.
  • Compared with other treatments, we don’t know as much about the long-term side effects, nor how well cryotherapy works to control prostate cancer in the long term (over 10 years).
  • Cryotherapy might miss some of the cancer cells during focal cryotherapy, which may mean your cancer comes back sooner.
  • Cryotherapy can kill healthy prostate tissue as well as cancer cells. Check with your surgeon about the risk of this happening. You could ask how much experience they’ve had, and what the results of previous treatments have been.

What does cryotherapy involve?

Each hospital does things slightly differently. We’ve included some general information. Your doctor or nurse will give you more information about what will happen before, during and after your treatment.

Before your treatment

Your bowels need to be empty during cryotherapy so that your doctor can get clear images of your prostate. Before the treatment, you might be given an enema to empty your bowels. An enema is a liquid medicine put inside your back passage (rectum).

You’ll also be asked not to eat for about six hours before the treatment. This is to make sure that no food can get into your lungs while you’re under general anaesthetic. But you will be able to drink water up to four hours before the treatment.

During your treatment

Cryotherapy is usually done under general anaesthetic, which is when you’re asleep and can’t feel anything. A urological surgeon will carry out the cryotherapy. You may also hear them called a urologist or consultant urologist. The technique is similar for both whole-prostate and focal cryotherapy.

  • First, a tube called a warming catheter is passed up your penis and into your bladder. Warm liquid goes through the catheter so that the urethra (tube you wee through) and urethral sphincter (muscles that control the flow of wee) are protected from the very low temperatures.
  • The surgeon then places a transrectal ultrasound (TRUS) probe inside your back passage, so that an image of your prostate can be seen on a screen. This is called TRUS guidance. It will show your surgeon where to put the needles so they can avoid damaging healthy tissue near the cancer cells, and the areas around your prostate.
  • Thin treatment needles are put into your prostate through the skin between your testicles and back passage (perineum), along with other needles (temperature probes) that check the temperature in and around your prostate. This helps to make sure the areas being treated reach the correct temperature for freezing, while the surrounding areas, such as your back passage, do not freeze.
  • Freezing gases are passed down the treatment needles, causing the temperature to drop to about ˗40oC. This destroys the prostate tissue by freezing it. Your prostate is then allowed to warm up, either naturally, by passing a different gas through the needles or by heating the needles using electricity. This process of freezing and warming is usually carried out two to three times. The whole process takes roughly one to two hours. The needles, probes and warming catheter are then removed.
  • At the end of the treatment, another tube is put through your penis (a urethral catheter) – or through a small cut in your lower tummy (a suprapubic catheter), but this is less common. The catheter drains urine out of your bladder and into a bag. Some hospitals may put in a suprapubic catheter before the cryotherapy starts, once you’ve had the general anaesthetic.

After your treatment

When you’re awake, you’ll be taken to the hospital ward or department to rest. You should be able to get up and walk around after a few hours, and eat and drink when you feel like it. Most men can go home the same day. Some may need to stay overnight.

It’s normal to have some bleeding or pain. You will be given pain-relieving drugs if you need them. You’ll also be given antibiotics 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
  • dark, cloudy or strong-smelling urine
  • needing to urinate more often than usual.

You might be given drugs called alpha-blockers, such as tamsulosin or alfuzosin. They help to relax the muscles in and around your prostate to help you urinate. You may need to take them for a few weeks or longer if you’re still having problems. Alpha-blockers can cause side effects, so ask your doctor or nurse about these if you’re worried.

Cryotherapy usually makes the prostate swell at first, 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 the hospital one to two weeks after your cryotherapy treatment. This may feel uncomfortable but should not be painful. You’ll need to stay at the hospital for a few hours afterwards to check that you can urinate properly.

When you go to the hospital to have your catheter removed, you may find that you leak urine at first. It’s a good idea to take spare underwear and trousers with you. Check if the hospital will provide incontinence pads to absorb the urine. If not, you can buy some at a pharmacy and take them with you.

It’s normal to see some blood and other tissue in your urine while you have the catheter in, and immediately after it’s taken out. You may also notice a little blood in your urine or semen off and on for up to three months after your treatment. Drinking plenty of fluids will help to clear the blood. If you see signs of infection, lots of blood clots in your urine, or bright red blood every time you urinate, then go to A&E straight away.

What happens next?

You will have check-ups with your doctor or nurse at the hospital. These are called follow-up appointments. They will include regular prostate specific antigen (PSA) blood tests to measure the amount of PSA in your blood. PSA is a protein produced by normal cells in the prostate and by prostate cancer cells. It’s a good way to check how well the cryotherapy has worked.

You may also have an MRI (magnetic resonance imaging) scan to check that all the cancer cells in your prostate were treated. If the MRI shows that the cancer might have come back, then you will have a biopsy to find out for sure.

How often you have check-ups will depend on your hospital, but you should have a PSA blood test roughly every three to four months for at least the first year, and every six months after that. Ask your doctor or nurse how often you’ll have PSA blood tests. If your cancer comes back, your doctor will talk to you about further treatment options. 

What are the possible side effects?

Like all treatments, cryotherapy can cause side effects. These will affect each person differently, and you may not get all of them. Your doctor or nurse can talk through the side effects with you. Tell them which side effects you’re most worried about, so they can help you decide if cryotherapy is right for you. The surgeon might also be able to show you the results of past treatments they’ve carried out. You could also ask if it would be possible to speak to someone they’ve already treated.

Most of the side effects are not as severe as the side effects of other treatments, such as surgery and radiotherapy. The most common side effects of cryotherapy are erection and urinary problems. These are caused by healthy tissue being frozen and damaged.

The side effects can be worse if you’ve already had another treatment, such as radiotherapy. This is because the area in and around your prostate may already be damaged.

Focal cryotherapy can cause similar side effects to whole-prostate cryotherapy, but they may not be as bad. This is because focal cryotherapy damages a smaller area of the prostate compared with whole-prostate cryotherapy.  

A common side effect of cryotherapy is problems getting or keeping an erection (erectile dysfunction). This is because the treatment can damage the nerves that control erections. You might also produce less fluid when you ejaculate, or you might not produce any.

Not all men experience erection problems after cryotherapy. And you’re more likely to experience this if you had problems before the cryotherapy. If you do have erection problems, you will usually notice them in the first few weeks after treatment. Usually, they will start to get back to normal within three months after the treatment.

Men often get their erections back after focal cryotherapy. But if you experienced erection problems after your first treatment for prostate cancer (such as radiotherapy), then they might get worse after salvage cryotherapy.

Not everyone gets their erections back. If this happens, there are treatments that can help. And doing pelvic floor muscle exercises can help to strengthen the muscles that control erectile function, as well as when you urinate.

If you need more support, talk to one of our Specialist Nurses on our sexual support service.

Cryotherapy can also cause urinary problems, such as leaking urine or trouble controlling your flow (incontinence). Most men will be back to normal within about six months. But others may have problems for longer.

You might have trouble emptying your bladder (urine retention). This happens because cryotherapy can cause your urethra to become narrow. This is called a stricture. It is less common than other urinary side effects.

Urine retention can lead to urine infections or painful bladder stones. If not treated, it can damage your kidneys, so it’s important to tell your doctor if you have symptoms. It may mean you will need to use a catheter for longer than two weeks after the treatment.

Urinary problems are more common in men who have salvage cryotherapy after radiotherapy. Read about ways to manage leaking urine or difficulty urinating.

The fluid that carries sperm is made in the prostate. Cryotherapy damages the prostate, so you may not be able to have children naturally after the treatment. If you want to have children, you can store your sperm in a sperm bank. Ask your doctor or nurse about this.

You might have some bruising and swelling around your testicles, buttocks and inner thighs for a few days after having cryotherapy. This can be worrying, but it’s 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.

It’s also normal to have some pain or discomfort for up to a two months after your treatment. You may experience pain in the area in or around your penis, testicles and back passage. You might also find it painful when you urinate.

You’re more likely to get pain if you had another treatment before cryotherapy. The pain usually improves, and pain-relieving drugs can help. Your doctor or nurse will tell you which ones to take.

You should be able to go back to your day-to-day activities within a few weeks or as soon as you feel able to. But it may take a few months before you feel completely back to normal.

In very rare cases, cryotherapy can cause a hole between your back passage and urethra. This is called a rectal fistula. It’s slightly more likely if you’ve already had another treatment before you have the cryotherapy. It’s also slightly more likely if you have whole-prostate cryotherapy. But it’s still very unlikely.

A rectal fistula can cause urine to leak from your urethra into your back passage, or bowel contents to leak from your bowel into your urethra. Signs include:

  • urine coming out of your back passage
  • pain in your pelvis or back passage
  • bowel contents in your urine
  • air bubbles in your urine
  • urine infections (but these can be caused by other things).

A rectal fistula can develop several months after treatment. Talk to your doctor or nurse straight away if you have symptoms. If you do have a fistula, you’ll need to have an operation to repair the hole.

Can I have further treatment after cryotherapy?

If the PSA level in your blood rises and your doctor thinks your cancer is growing, then there are other treatments you can try. These include:

The stage and grade of your cancer will also help your doctor decide which further treatment might be best.

Read more about the treatment options for localised prostate cancer, locally advanced prostate cancer and advanced prostate cancer.

Dealing with prostate cancer

Being diagnosed and living with prostate cancer can change how you think and feel about life. If you or your loved one is dealing with prostate cancer, it’s normal to feel scared, stressed or even angry. Lots of men with prostate cancer can get these kinds of thoughts and feelings. But there is no ‘right’ way to feel and everyone reacts in their own way. You may find it helpful to read our information on living with prostate cancer. Our Wellbeing Hub has information to support you in looking after your emotional, mental and physical wellbeing.

If you are close to someone with prostate cancer, find out more about how you can support them and where to get more information.

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.

  • Where is cryotherapy available?
  • What are my other treatment options?
  • Will I have focal or whole-prostate cryotherapy?
  • What are the side effects of cryotherapy, how likely am I to get them, and how can they be managed?
  • How often will you check my PSA after the treatment?
  • How will I know if the treatment has worked?
  • How likely is it that I’ll need more treatment after cryotherapy?
  • What treatments are available after cryotherapy?

References and reviewers

Updated: August 2025 | To be reviewed: August 2028

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  • Hashim Ahmed, Consultant Urological Surgeon, Imperial College London
  • Gordon Muir, Consultant Urological Surgeon, London Bridge Hospital
  • Karen Wilkinson, Clinical Nurse Specialist, University College London Hospitals NHS Foundation Trust
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