WHY
CRYOSURGERY?
This
paper was written by Colin Campbell and presented to the Owen Sound Support Group
in July 2004. Collin is a mechanical engineer who had radiation as the primary
treatment for prostate cancer. The radiation caused impotence, incontinence, and
proctitis .The radiation nevertheless failed and the cancer recurred. Salvage
Cryotherapy was attempted, but the cancer had become systemic so it was too late
.At the present time the author is undergoing androgen deprivation therapy (ADT).
You can read his story here.
Of all the options for the treatment of Prostate Cancer, Cryosurgery
is least mentioned. Yet Cryosurgery is an effective treatment for prostate cancer
and should be considered more often than it is.
Men who are diagnosed
with prostate cancer are usually advised to have the therapy their urologist is
most familiar and comfortable with, which is understandable. This can be some
form of Radiation, Radical Surgery, Brachytherapy (Radioactive seed implant),
Laparoscopic surgery, Intensity modulated radiation therapy (IMRT), Proton Beam
(uncommon). Cryoablation is relatively uncommon.
.
Men over 70 years
are not considered good candidates for Radical surgery, unless they are in extremely
good health, when it may be an option. For this class of patients, radiation is
often suggested. Only rarely is Cryosurgery recommended
The lack of popularity
of Cryosurgery is probably because many urologists have no experience with the
technique. Urologists recommend procedures that they are familiar with, and modern
automated Cryosurgery is relatively new on the scene.
It can be shown
that modern Cryosurgery, done by an expert, provides cure statistics comparable
to a radical prostatectomy (RP) In addition cryosurgery is likely to give fewer
side effects, while allowing quicker recovery than an RP. It is well tolerated
by men aged 70 or more .As with all therapies, a high degree of competency is
required of the surgeon. Experience is essential for a good outcome.
The technological advances in the use of 3D Color Doppler Ultrasound, which is
an integral part of modern cryosurgery, give the therapy a new dimension. This
is illustrated in the August 2002 issue of Urology, which shows excellent outcomes
over seven years, and six hundred men who had been treated using an earlier, less
sophisticated technology.
Freezing of cancerous tissue on skin has been
used successfully for many years and indeed is the standard of care for many tumors.
If the tumor can be reduced to minus forty degrees it dies. Period ! Adjacent
healthy tissue is not affected and if the initial treatment misses any of the
cancer it can be repeated as many times as necessary.
Similarly, radiation
also kills tumors, provided that sufficient radiation is applied. However, some
tumors require more radiation than is safe for adjacent healthy tissue. There
is an upper limit to radiation that cannot be exceeded. It usually takes about
two years after radiation to tell if the tumor has died. If radiation is unsuccessful,
the patient will probably be left with a more aggressive cancer and additional
radiation is not possible. Radiation may cause collateral damage to adjacent organs
such as the rectum, colon and bladder resulting in radiation proctitis, bleeding
incontinence and impotence!
The American Urology Association approves
primary Cryotherapy and Medicare covers it in the USA.
In Canada, with the exception of the Province of Alberta where Cryo has recently
been approved and covered by the Provincial Health Insurance, there is one urologist
in Windsor Ontario who offers this procedure on a patient pay basis. He was the
second of the author's Cryosurgeons and is highly experienced.
