Cryotherapy, also called cryoablation, is a treatment that uses very low temperatures to treat prostate tissue. It may be considered for selected people with prostate cancer, including in some cases as a focal treatment aimed at the part of the prostate containing clinically significant cancer.
Cryotherapy is not a routine treatment for everyone with prostate cancer. Whether it is appropriate depends on the location and extent of the cancer, previous treatments, MRI and biopsy findings, general health and the expertise available at the treating centre.
Read NHS information about prostate cancer treatment.
How is cryotherapy carried out?
Cryoprobes are placed into the prostate using imaging guidance. Low temperatures are then produced around the probes to treat the targeted prostate tissue.
The procedure may be carried out under general or regional anaesthesia. A catheter is commonly used during or after treatment, and the treatment team takes measures to protect nearby structures.
Whole-gland and focal cryotherapy
Cryotherapy can be used to treat the whole prostate or, in selected cases, as focal therapy aimed at a particular area of cancer.
Focal cryotherapy aims to reduce effects on healthy prostate tissue and nearby structures, but prostate cancer can occur in more than one area of the gland. Careful MRI, biopsy assessment and follow-up are therefore important.
What does NICE say about cryotherapy?
NICE guidance on cryotherapy as a primary treatment says that evidence on safety and shorter-term measures of effectiveness is sufficient for the procedure to be used with normal arrangements for consent, audit and clinical governance. NICE also notes uncertainty about long-term survival and quality-of-life outcomes.
For focal cryotherapy, NICE says there are no major safety concerns but evidence about effectiveness is limited. It recommends special arrangements for clinical governance, informed consent, audit or research, with patient selection by a multidisciplinary urological cancer team.
Read NICE guidance on focal cryotherapy for localised prostate cancer.
When might cryotherapy be considered?
Cryotherapy may be discussed for selected people with cancer that is confined to the prostate. It has also been used as a salvage treatment when prostate cancer returns within the prostate after radiotherapy.
Your specialist team should explain why cryotherapy is being considered and how it compares with other options that may be suitable for you, such as active surveillance, surgery or radiotherapy.
Possible side effects
Possible effects can include erectile problems, urinary discomfort or urgency, difficulty passing urine, urine leakage, urinary infection, narrowing of the urethra, and needing a catheter after treatment.
Less common but potentially serious complications can occur. Your specialist team should explain the risks associated with the particular type of cryotherapy being proposed.
Follow-up after cryotherapy
Follow-up is important after cryotherapy and may include PSA blood tests, MRI scans and, in some circumstances, further biopsy. After focal treatment, untreated prostate tissue remains in place, so ongoing monitoring is particularly important.
Questions to ask your specialist
- Why do you think cryotherapy is suitable for my cancer?
- Would you treat part of my prostate or the whole gland?
- What are the alternatives in my case?
- What is known about the long-term results for someone with my type of cancer?
- What urinary and sexual side effects are most likely for me?
- What follow-up tests will I need?
- What treatments would remain available if the cancer returns?
This information provides a general introduction to cryotherapy for prostate cancer and does not replace advice from your urologist, oncologist or specialist cancer team.