If you've been diagnosed with prostate cancer, determining your treatment plan can be stressful and overwhelming. There is no single "best" course of action; it depends on you, your lifestyle goals, and your specific type of cancer.
Prostate cancer can be treated with active surveillance, radiation therapy, medical & hormone therapies, surgery, and various ablation procedures such as cryotherapy. Prostate cancer specialists, such as the Urologic Oncologists at Weill Cornell Medicine, will help you customize the right treatment plan for you.
Dr. Jim Hu, Ronald P. Lynch Professor of Urologic Oncology, explains, "I believe in excelling at all treatments for prostate cancer so that we offer them equally and fairly to all patients. This way, the patient chooses what is best for him."
What is cryotherapy?
Cryotherapy (also called "cryosurgery" and "cryoablation") is a minimally invasive surgical technique that uses extreme cold to destroy abnormal tissue, including cancer.
For prostate tumors, the surgeon places a hollow instrument (called a cryo-needle) in contact with the tumor. The doctor uses imaging to guide the cryo-needle and freeze the cancer cells. The freeze and thaw cycles destroy cancer cells because as the cells freeze, ice crystals form inside and around them.
Although cryotherapy has been available for over 30 years for prostate cancer, it was traditionally performed for whole gland treatment in the operating room using general anesthesia. It has only very recently been offered as an in-office procedure.
In fact, Dr. Jim Hu and NewYork-Presbyterian/Weill Cornell Medicine are the first in New York and the Northeast region to perform the prostate cryotherapy both as an in-office procedure using the precision of MRI-Ultrasound fusion guidance and only local anesthesia.
According to Dr. Hu, "Patients enjoy the convenience of the procedure. They walk in and out within 45 minutes and have few restrictions beyond the first 24 hours. It is relatively new, and we must guide men with appropriate cancer characteristics in terms of the pros and cons."
Benefits of cryotherapy for treating prostate cancer
With cryotherapy, we are focusing the ice ball on cancerous areas of the prostate only. Therefore the greater risks for incontinence, erectile dysfunction, or damage to surrounding structures that are inherent to whole gland treatments—such as radiation or surgery—are minimized with cryotherapy.
The procedure also is performed in the office during one session and does not require general anesthesia, allowing minimal disruption of activities of daily living and avoids time away from work or exercise. Finally, the procedure may be repeated and allows for follow-up with whole gland treatments if the cancer recurs.
This minimally invasive procedure has proved to be an effective treatment for early-stage prostate cancer, particularly when the cancerous tissue is confined to the prostate gland. The benefits of prostate cryosurgery include:
- Less pain, bleeding, and complications than other cancer treatments because it is a needle-based treatment that does not require incisions
- Very little healthy skin and cells are damaged; the treatment uses imaging tools (MRI and ultrasound) to identify the specific cells that need to be treated
- The procedure may be repeated as necessary
- Recovery is fast; you might need to stay in the hospital overnight, but almost all men walk out of the clinic a few hours later
- May help shrink an enlarged prostate and improve urinary flow
Potential disadvantages
The use of minimally invasive, ultrathin cryo-needles and more precise imaging techniques, like MRI-ultrasound fusion, has decreased the occurrence of many side effects.
These common side effects usually subside after a few days:
- Blood in the urine and semen
- Soreness in the area where the needles were placed
- Decreased or trouble controlling urine flow due to tissue swelling
In rare cases, the surgery has caused injury to the rectum; however, this is extremely uncommon, because Dr. Hu is actively monitoring the ice ball during treatment. Finally, because the application of this procedure for targeted therapy has only been around for a few years, the long-term outcomes need to be carefully studied and monitored.
Expertise at Weill Cornell Medicine
Dr. Hu is internationally renowned as a surgical innovator and health services researcher. He came to Weill Cornell Medicine in February 2015 after setting up internationally renowned programs at Brigham and Women's Hospital/Harvard Medical School and UCLA Medical Center where he served as Director of the Prostate Cancer and Robotic and Minimally Invasive Surgery Programs, respectively.
In the summer of 2017, Dr. Jim Hu performed the first in-office MRI-Ultrasound fusion-guided prostate cryotherapy in New York and Northeast region. With MRI-Ultrasound fusion guidance, the physician is better able to target the specific region(s) in a patient's prostate that has cancer.
Additionally, using only local anesthesia means that the procedure is more comfortable and convenient for the patient, with less time spent in the hospital when compared to the traditional use of general anesthesia for prostate cryotherapy.
"This is a revolutionary approach to the treatment for prostate cancer," explains Dr. Hu, "where patients can walk in and out of the office and have their prostate cancer treated, much like a dental procedure."
