Prostate Cancer Options

Current Treatment Options:

Thanks to a simple PSA (prostate specific antigen) blood test, 60% of cases are diagnosed while the cancer is still confined to the prostate gland. If detected early, the survival rate for patients after five years is 100%. Many treatment options are available, ranging from "watchful waiting" to removal of the prostate (radical prostatectomy), and from radiation therapy (external beam or implantable pellets) to cryotherapy.

Current Treatment Options:

Thanks to a simple PSA (prostate specific antigen) blood test, 60% of cases are diagnosed while the cancer is still confined to the prostate gland. If detected early, the survival rate for patients after five years is 100%. Many treatment options are available, ranging from "watchful waiting" to removal of the prostate (radical prostatectomy), and from radiation therapy (external beam or implantable pellets) to cryotherapy.

What is Cryosurgery?

Cryotherapy is an effective yet minimally invasive alternative to surgery and radiation therapy. It uses slender probes, called cryoprobes, to deliver a lethal freeze to destroy the tumor and surrounding tissue. Under ultrasound guidance the probes are inserted through the skin and are strategically placed in and around the prostate to target the entire gland and minimize damage to surrounding healthy structures. A warming catheter protects the urethra (urine channel) while the probes freeze the cancerous tissue at temperatures of -40° Celsius. The procedure is done under either general or epidural anesthesia. Since it is minimally invasive, it offers patients a quicker recovery and reduced severity of potential side effects such as incontinence. Without the expense associated with major surgery or an extended hospital stay, cryosurgery is a cost-effective treatment option.

Dr Bevan-Thomas offers cryosurgery for the treatment of prostate cancer and renal cancer. Watch this 1.5 minute video presentation of the procedure.
[ Watch Video ]

Recent technological advancements have introduced a safer and more effective cryosurgical procedure called Targeted Cryoablation of the Prostate (TCAP). TCAP uses between six and eight ultrasound-guided cryoprobes to deliver a lethally cold temperature to specific areas in the prostate. The resulting iceball that forms insures that all cancer cells are immediately destroyed. It also uses thermosensors that enable surgeons to monitor the process and determine when the exact target temperatures have been reached. The treatment is highly effective for low, moderate and high risk localized prostate cancers; freezing kills cancer cells on contact regardless of how aggressive they are.

Impotence is an expected side effect of targeted cryosurgery due to the freezing of tissue outside the gland to kill cancer cells that may have spread. This safety measure reduces the possibility of any additional tissue becoming malignant. New nerve-sparing procedures can preserve sexual function after cryotherapy for qualified patients and even patients who have undergone a complete ablation may regain erectile function after appropriate erectile rehabilitation. Unlike radical prostatectomy or radiation therapy, cryotherapy can be repeated if necessary. Clinical data indicates that for locally confined high-grade prostate cancer, cryotherapy offers the highest average long-term success rates across all stages of localized prostate cancer. This targeted freezing procedure is minimally invasive, enabling patients to sustain the highest quality of life possible.

	What to expect with Prostate Cryosurgery Procedure: - 1.5-2 hours under spinal or general anesthesia - Home later that day or the next day After procedure: - Icepacks to scrotum and perineum for 3-5 days - Suprapubic or Foley catheter for 1 week - Anti-inflammatory medications for several days - Can start golfing at 10-14 days
	Early Side effects of Prostate Cryosurgery Swelling around scrotum and perineum for up to two weeks Urinary retention Uncomfortable to sit down (< 2 wks) Late side effects of cryosurgery Impotence 82-100 % initially, 47% have recovery after 3 years Urethro-rectal fistula (0-0.25%) Incontinence (1-4%) TURP needed (1-5.5%)
	Prostate Cryosurgery Advantages Minimally invasive, minimal pain Hospitalization less than 24 hrs, brief recovery Favorable success & complication rate Very effective in patients at risk for positive margins Can be repeated Radiation or surgery is still an option for failures Excellent option for patients after failing radiation or brachytherapy
	Prostate Cryosurgery Disadvantages Early Impotency (potentially permanent) Prostate should be < 45 gms Most larger glands can be downsized with several months of hormone therapy Catheter or suprapubic tube for 1 week

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