About Orlando Cryotherapy

Cryotherapy gives Orlando prostate cancer patients an alternative to traditional prostate cancer treatments such as surgery and chemo/radiation.

Cryotherapy translates literally to “destruction of tissue by cold.” The concept of using sub-zero temperatures in the treatment of prostate cancer has been around since the 19th century when mixtures of ice and salt were applied to the breast or cervix for the treatment of cancer. Modern cryotherapy began in 1966 with the use of liquid nitrogen. Today, third generation cryotherapy needles are used more effectively through the guidance of the transrectal ultrasound. Only recently has the technology become available that allows a surgeon to accurately place and form an ice ball that will destroy the prostatic tissue effectively. The technological advances include the switch from cryoprobes to cryoneedles, the use of the transrectal ultrasound for guidance, the switch from liquid nitrogen to argon and helium gases, and the use of a warming urethral catheter.

The planning of the minimally invasive surgery is done as part of the procedure. The patient is placed under general anesthesia. The entire procedure will take one or two hours. The patient is placed in stirrups, legs lifted to a 90 degree angle, and opened, and his perineum is placed just over the edge of the operating table. This position gives the doctor a clear view of the procedure site. The patient is shaved and cleaned from the perineum to the navel. The surgeon will then insert a catheter via the penis into the bladder. The surgeon will use transrectal ultrasound (TRUS) to obtain a picture of the prostate gland and surrounding organs. A transperineal needle template that will guide the cryoneedles is attached to a stabilizing device and gently fixed against the skin of the perineum. Under TRUS the cryoneedles will be placed in the prostate, covering the area that Dr. Lotenfoe wants to treat. The needles are inserted into three or four horizontal layers with two to three needles per layer. The number of cryoneedles depends on the size of the patient’s prostate gland and the extent of his prostate cancer. In prostate cryotherapy, the third generation needles have made it possible to treat the prostatic capsule and the seminal vesicles. As many as five thermal sensors will be inserted into the critical parts of the prostate such as the apex,  the urinary sphincter, and each neurovascular bundle. This assures adequate coverage by the ice ball, as well as containment of the ice ball, assuring adequate treatment and at the same time minimizing the chances of side effects. After the needles have been positioned, the catheter is removed and the doctor examines the urethra with a cystoscope for any misplaced needles and probes. The doctor will reposition needles if necessary. After this inspection, a warming catheter is inserted into the urethra. A warm saline solution is circulated through the warming catheter to protect the urethra from sustaining freeze damage. Argon gas is released from a high pressure tank and circulated through the cryoneedles. Just like the refrigerator and freezer at home, the rapid expansion of the gas causes a severe lowering of the temperature. The freezing gas creates ice balls around the needles. Ice crystals form inside of the cells and this kills them. Freezing also may activate an anti-tumor response of the body, which occurs when the body recognizes the tumor as an invading agent and attacks the disease itself. The freeze cycle lasts about 10 to 15 minutes or until adequate, lethal temperatures are reached at the treatment area. There are two types of thawing processes. One is passive: the doctor allows the relative temperature of the body to return the prostate gland to normal temperature. The other is active: the doctor circulates helium gas through the cryoneedles. Helium has the property of staying warm (well above freezing) even when decompressed rapidly and circulated through the cryoneedles. The helium speeds up the thawing process. The freeze-thaw cycle is repeated once or twice . The choice between passive or active thawing is at at the discretion of the treating physician. There are no absolute pros or cons regarding either choice. After the procedure, the warming catheter is left in place for at least another ten to fifteen minutes to reduce the risk of urethral freezing, which would  result in sloughing. After the warming catheter is removed, a urinary catheter is inserted in its place to drain the bladder as the prostate will swell up. The new catheter will be removed in 5-10 days. Patients are usually discharged the same day of the procedure. The Doctor will usually prescribe pain medications, antibiotics and an anti-spasmodic which will relax the bladder and decrease the severity of urinary side effects.
Call the Orlando Cryo Center today to see if Cryotherapy is the right prostate cancer treatment for you, 407-584-7771.




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