Cryotherapy

Cryotherapy freezes the prostate to destroy cancer cells. In international series it has been used in a limited number of high-volume centres for primary treatment, and is discussed more often in salvage settings after radiotherapy failure.

Mechanism

Cryoprobes deliver a freeze-thaw cycle to planned regions of the gland under imaging guidance. The exact probe layout and temperature monitoring depend on the device and operator.

Role in salvage therapy

Reviews and case series discuss cryotherapy after radiation when local recurrence is suspected and the patient wishes to avoid or delay some whole-gland options.6

Concerns

  • Significant erectile dysfunction rates are reported in some series.6
  • Long-term cancer control data require careful comparison with radical surgery and radiotherapy cohorts matched by risk.
  • Use in Australia has been limited; classify as experimental or trial-based unless your unit states otherwise.
Salvage cryotherapy carries different risks from primary treatment. Discuss urinary symptoms, incontinence risk, fistula risk and follow-up biopsy or imaging protocols with your treating team.
References
  1. The clinical applications of high intensity focused ultrasound in the prostate - Rowland Illing and Alexander Chapman - International Journal of Hyperthermia, 23(2), 183-191 - https://doi.org/10.1080/02656730601173037
  2. High-intensity focused ultrasound with visually directed power adjustment for focal treatment of localized prostate cancer: systematic review and meta-analysis - Samuel J. Peretsman, Mark Emberton, Neil Fleshner, et al. - World J Urol 42, 175 (2024) - https://doi.org/10.1007/s00345-024-04840-6
  3. What is HIFU - Cancer Research UK - https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/high-intensity-focal-ultrasound-hifu
  4. Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer - Sunao Shoji, Satoshi Kuroda, Kohei Uemura, et al. - Biomedicines. 2022 Nov; 10(11): 2876 - doi: 10.3390/biomedicines10112876
  5. High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment - Mohammed Alkhorayef, Mustafa Z. Mahmoud, Khalid S. Alzimami, et al - Pol J Radiol. 2015; 80: 131-141 - doi: 10.12659/PJR.892341
  6. Cryotherapy for Primary Treatment of Prostate Cancer: Intermediate Term Results of a Prospective Study from a Single Institution - S. Alvarez Rodríguez, F. Arias Fúnez, C. Bueno Bravo, et al. - Prostate Cancer. 2014; 2014: 571576 - doi: 10.1155/2014/571576 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945790/

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