Non-Surgical Prostate Cancer Treatment

Non-surgical prostate cancer treatment refers to methods that may be considered as alternatives to open surgery or procedures in which the prostate is completely removed. One of these methods, cryoablation, is a minimally invasive procedure that aims to destroy cancerous areas in the prostate tissue by freezing them in a controlled manner. Also known as prostate cancer freezing treatment, this method may be considered as a local treatment option, especially in selected patients. The treatment decision is made by evaluating the location of the tumor within the prostate, the stage of the disease, PSA level, biopsy result, previous treatments and the patient’s general health condition together.

Cryoablation is not a standard treatment for every prostate cancer patient. The suitability of this method should be assessed together with whether the cancer has spread outside the prostate, the size of the tumor, the patient’s eligibility for surgery and the expected benefit from treatment. Therefore, cryoablation should be explained separately in the context of both prostate cancer and benign prostatic enlargement. In this way, prostate cancer and BPH are not presented as the same disease, and it becomes clearer how the freezing method may be considered in each condition.

What Is Cryoablation?

Cryoablation, also known as cryotherapy, is a minimally invasive treatment method that destroys prostate cancer cells by freezing them at low temperatures. During this procedure, a special cryoprobe is used to freeze and destroy tumor tissue. Moreover, large incisions like those used in open surgery are not required.

How Does Cryoablation Work in Prostate Cancer? 

Prostate cancer freezing treatment is based on the principle of destroying cancerous tissue with cold instead of burning it with heat. During freeze-thaw cycles, ice crystals form inside and around the cells. This process damages the cell structure, affects blood supply and causes the targeted tissue to be destroyed over time.

This method can be applied to the entire prostate gland, or in some selected patients, it may be considered as a focal treatment approach targeting only the cancerous focus. In the focal approach, the aim is to treat the cancerous area while preserving the prostate and surrounding tissues as much as possible. However, the location, number, spread risk and biopsy result of the tumor must be carefully evaluated for this approach.

Who Is Cryoablation Suitable For in Prostate Cancer?

• Patients with early-stage prostate cancer
• Patients who do not prefer surgery or radiotherapy
• Older patients who are not suitable for surgery
• Cases of recurrent prostate cancer after radiotherapy 

Prostate cancer cryoablation treatment is not applied in the same way for every patient. Proper patient selection is important for treatment success and for reducing the risk of side effects. Cryoablation may generally be considered in patients with localized or selected early-stage prostate cancer that has not spread outside the prostate.

Cryoablation for prostate cancer may be considered in the following groups:

How Is Cryoablation Applied in Prostate Cancer?

Cryoablation may be planned under local, spinal or general anesthesia. During the procedure, special cryoprobes are guided into the prostate tissue and the areas planned for treatment are frozen in a controlled manner. The procedure is usually performed under ultrasound or other imaging guidance. In some applications, a warming catheter may be used to help protect the urethra and surrounding tissues.

The application steps are generally as follows:

1. Local or general anesthesia is administered to the patient.
2. Thin cryo needles are placed into the prostate gland.
3. Prostate tissue is frozen using liquid nitrogen or argon gas.
4. The frozen cancer cells are gradually eliminated by the body.
5. The patient is discharged shortly after the procedure.

As a minimally invasive prostate treatment, this method may require a more limited intervention compared with open surgery. However, recovery time, urinary complaints, sexual functions and PSA follow-up after the procedure may vary from person to person.

Cryoablation Freezing Method in Benign Prostatic Enlargement (BPH)

Cryoablation is a minimally invasive option used in many cancer types and may also be used in benign prostatic enlargement. The procedure is performed under general or spinal anesthesia. With real-time imaging, cryoprobes are placed into the prostate through the transperineal route. The probe tips rapidly freeze the tissues to temperatures between -40 and -196 °C. Patients are generally discharged on the same day.

Can Cryoablation Be Applied to Everyone in BPH Treatment?

It cannot be said that cryoablation is suitable for every patient in BPH treatment. It may be considered especially in patients with large prostates, those who are not suitable for surgery or those who require evaluation for different treatment options. However, the suitability decision is not made based only on prostate size.

The severity of the patient’s urinary complaints, prostate volume, bladder function, previous procedures, medications used and general health condition should be evaluated together. Therefore, cryoablation for BPH should be planned after a detailed evaluation by a urology specialist.

Advantages of Cryoablation

The advantages of cryoablation become more apparent with proper patient selection. This method can be applied with more limited incisions or needle entries compared with open surgery. In some patients, hospital stay may be shorter and return to daily life may be faster.

The main advantages of cryoablation include:

• It is minimally invasive: It may carry fewer risks than surgery.
• Faster recovery process: Patients can usually return to daily life in a short time.
• Repeatable: It can be applied to the same area again if needed.
• Fewer side effects: It may have fewer side effects compared with radiotherapy.

These advantages do not produce the same outcome for every patient. Tumor location, prostate volume, previous treatments, urinary functions and general health condition affect the post-treatment process. Therefore, the decision for cryoablation should be made through an individual evaluation.

Recovery Process After Cryoablation 

The recovery process after cryoablation generally varies depending on the patient’s overall condition, the extent of the procedure and the anesthesia method used. Some patients may be discharged on the same day or after short-term monitoring. Temporary difficulty urinating, frequent urination, burning sensation or changes in urine flow may occur after the procedure.

During the recovery period, fluid intake, regular use of medications, compliance with follow-up appointments recommended by the physician and  PSA monitoring are important. Heavy physical activities may need to be avoided for a while. Sexual functions, urinary control and complaints related to the procedure area may vary from person to person.

Some effects after cryoablation may be temporary, while others may last longer. Therefore, possible side effects and the follow-up plan should be clearly discussed before the procedure.

Possible Side Effects and Points to Consider

Although cryoablation is a minimally invasive method, it is not free of side effects. Temporary urinary problems, burning during urination, frequent urination, weak urine flow or urinary incontinence may occur after the procedure. Since the nerve structures around the prostate may be affected by the cold effect, erectile function may also change.

Possible side effects may include:

• Temporary urinary problems may occur.
• There is a risk of nerve damage due to cold exposure, so proper patient selection is important.
• Regular PSA testing should be performed after the procedure.

Why Is PSA Follow-Up Important After Cryoablation? 

PSA level after cryoablation is an important follow-up tool for evaluating response to treatment. PSA monitoring in prostate cancer is used to observe whether the cancerous tissue is under control after the procedure and to detect possible recurrence early. How PSA is interpreted may vary depending on whether cryoablation targeted the entire prostate or only a focal area. 

PSA is not always expected to decrease to zero after cryoablation because the entire prostate tissue may not have been removed. Therefore, PSA results should be evaluated together with previous values, procedure type, imaging findings and the possible need for biopsy. EAU follow-up recommendations indicate that PSA monitoring after treatment is usually performed more closely in the first years and may continue with annual controls in the following period.

Differences Between Cryoablation, Robotic Surgery and Radiotherapy

The main difference between cryoablation and robotic surgery is that the prostate gland is removed in surgery, while in cryoablation the targeted tissue is destroyed by freezing. Radiotherapy, on the other hand, is a non-surgical method; however, it targets cancer cells with radiation energy, not freezing. Therefore, treatment selection should not be based only on the distinction between “surgical” and “non-surgical”; the stage of the disease, risk level and the person’s overall condition should be considered.

Cryoablation in Recurrent Prostate Cancer After Radiotherapy 

In recurrent prostate cancer after radiotherapy, cryoablation may be considered as a salvage treatment in some patients. This usually becomes an option when the cancer recurs locally within the prostate, no distant spread is detected and the patient’s general condition is suitable for the procedure.

In the decision for salvage cryoablation, PSA elevation, imaging findings, confirmation of recurrence with biopsy and the effects of previous radiotherapy on tissues are evaluated together. Since tissue sensitivity may increase after radiotherapy, the risks related to the urinary tract, rectum and sexual functions should be discussed in detail.

Therefore, cryoablation is not an automatic option for every patient with recurrence after radiotherapy. It may be applied in selected patient groups, and the decision should be made after a detailed urological evaluation.

Evaluation of Prostate Treatment With Cryoablation in Ankara

For people searching for prostate cancer treatment in Ankara, cryoablation is one of the methods encountered when researching non-surgical or minimally invasive options. However, the suitability of this method is not determined only by the patient’s unwillingness to undergo surgery. Prostate MRI, PSA level, biopsy result, number of cancer foci, tumor location within the prostate and risk of spread should be evaluated together.

An Ankara urology specialist evaluation is important in determining whether cryoablation is suitable for prostate cancer or benign prostatic enlargement. Since the same method can be used for different purposes in different diseases, the treatment decision should be made through an individual evaluation.

Cryoablation may be a freezing-based, minimally invasive treatment option for prostate cancer in suitable patients. It may be considered in early-stage prostate cancer, local recurrence after radiotherapy or in some patients who are not suitable for surgery. In benign prostatic enlargement, the aim is not cancer treatment but reducing the tissue that puts pressure on the urinary tract. Therefore, correct patient selection, pre-procedure evaluation and post-procedure PSA follow-up are essential parts of the treatment process.

Frequently Asked Questions About Non-Surgical Prostate Cancer Treatment

When Does PSA Decrease After Cryoablation?
PSA decrease after cryoablation varies from person to person and may differ depending on whether the procedure was applied to the whole prostate or only to a focal area. PSA level is monitored through regular follow-up visits.

Does Cryoablation Completely Eliminate Prostate Cancer?
Cryoablation aims to destroy the targeted cancerous tissue by freezing it. Treatment success is evaluated according to the stage of the disease, tumor location and follow-up results after the procedure.

Is Freezing Treatment for Prostate Cancer Painful?
Since the procedure is performed under anesthesia, pain is not expected during the application. Temporary tenderness, urinary complaints or pelvic discomfort may occur after the procedure.

Is Hospitalization Required After Cryoablation?
Some patients may be discharged on the same day, while short-term observation may be required for others. This decision depends on the type of anesthesia, the extent of the procedure and the patient’s general condition.

Can Urinary Incontinence Occur After Cryoablation?
Temporary or longer-lasting urinary control problems may occur in some patients after cryoablation. The risk varies depending on the treatment area, prostate structure and previous treatments.

Does Cryoablation Affect Sexual Function?
Since the nerve structures around the prostate may be affected by the cold effect, erectile function may change. This risk should be evaluated before the procedure together with the patient’s condition and treatment plan.

Can Cryoablation Be Performed After Radiotherapy?
Cryoablation may be considered in selected patients with prostate-confined recurrence after radiotherapy. PSA, imaging and biopsy results should be evaluated together to determine suitability.

How Long Does Prostate Cancer Freezing Treatment Take?
The duration of the procedure varies depending on the extent of the application, prostate volume and the method used. It is generally planned together with preparation, anesthesia and post-procedure monitoring.

Can Cancer Recur After Cryoablation?
The possibility of recurrence is not completely eliminated after cryoablation. Therefore, regular monitoring with PSA follow-up, imaging and biopsy when necessary is important.

Is Cryoablation for BPH the Same as Cryoablation for Prostate Cancer?
No, their purposes are different. In prostate cancer, the aim is to destroy cancerous tissue, while in BPH, the goal is to reduce the benign enlarged tissue that puts pressure on the urinary canal.