INDICATIONS FOR
CRYOTHERAPY
Cryotherapy is indicated in patients:
-
With newly diagnosed cancer regardless of Gleason's Score
-
For patients who fail External Radiation. With external radiation, there is a 40% incidence of failure in patients with a high Gleason's Score. The performance of Cryotherapy in these patients is called Salvage Cryotherapy.
-
With proven cancer in ONLY one lobe, either the right or left lobe. These patients can qualify for Cryotherapy to treat ONLY the cancerous lobe. This procedure is called MALE LUMPECTOMY. In these patients, the cancer free lobe will not be frozen, and neither will the nervi-erigendi of that side. These patients will not develop impotence.
-
With localized advanced cancer and a high Gleason's Score, who may not be candidates for open or Robotic Surgery, or who prefer less invasive surgery.
-
With early metastasis who are not candidates for surgery, here cryotherapy, in conjunction with Hormonal Therapy and/or Chemotherapy, is an option.
The most common complication in the majority of
patients is a temporary Erectile Dysfunction at
a high percentage (90%) iin the first 6 months.
This is because the Nervi Erigendi, that
anatomically enter inside the Corpora Cavernosa
of the penis and discharge special chemical
substances to produce an erection upon arousal, are the nerves that are
attached
to the capsule of the prostate in the right and
left lateral areas.
As a result of their location, these nerves may
be damaged during radical surgery and
by External Radiation, and also occurs at a high
percentage during Cryotherapy.
2.
The incidence of Recto-Urethral fistulas (abnormal communication between the rectum and urethra) is below 1% with the new Third Generation Cryotherapy (2005) except if Cryotherapy is done for Salvage Cryotherapy (patients who have failed External Radiation.) Here, the incidence can be up to 5% because cryotherapy is done on previous tissue damage by previous radiation.
3. Urinary Incontinence
The incidence of incontinence also remains below 1%, except in cases of Salvage Cryotherapy, in which the incidence can be up to 5%.
Sagital View of Prostate
Before Cryotherapy
End of Freeze
TREATMENT OF
ERECTILE
DYSFUNCTION
AFTER
CRYOTHERAPY
This treatment is similar for patients who become impotent after Radical Surgery. The Early Penile Rehabilitation Program starts at 3 months from the procedure by use of vacuum devices therapy, oral medications, and direct small penile shots of Prostaglandins or similar substances that will produce an erection for 30-40 minutes. If all of these fail, a penile prosthesis of choice will resolve the problem of impotence.
Post Cryotherapy Biopsy at 6 months: Gives Fibrosis Tissue in the Prostate