Cryosurgery an Excellent Option for Prostate Cancer Patients

At every step in his battle with cancer, 59-year old Ray Haller had access to cutting edge tools that led to his diagnosis and remarkably quick recovery. From the initial tests that led to the discovery of cancer, to his treatment with an innovative procedure that kills cancer while minimizing side effects, Haller benefited from the constant and rapid advances of medical technology.

A prostate cancer survivor, Haller says the hard-to-find tumor in his prostate gland was discovered because of a combination of regular PSA testing and advanced ultrasound guided biopsy technology.

When Haller switched physicians 17 years ago, his new doctor insisted he have a benchmark PSA test performed. Prostate Specific Antigen tests measure the amount of a protein in the blood produced by the prostate gland. A sudden jump in the PSA level may signal the presence of cancer in the prostate. Haller's original PSA test was 3.2, and it had always been around that level. So in January 2002, when his PSA jumped to 4.8, he had a biopsy preformed.

Thanks to ultrasound technology, Haller's urologist was able to find the tumor. "It was in the upper rear of the prostate-toward the belly, so it was kind of hidden," Haller says of the tumor. "Without the ultrasound, a biopsy might not have caught it."

Once diagnosed, Haller did a lot of research, spoke with a number of doctors and prostate cancer patients, and ultimately opted for a cutting edge approach that involves freezing the prostate gland to kill it and the cancer within it. Two years since undergoing the procedure, Haller remains cancer free, with his PSA tests consistently less than 0.1. He continues to work in a physically demanding job, regularly works out at the gym, and pursues personal interests including martial arts, archery, shooting and white water rafting.

Technology advances lead to another treatment option

Until fairly recently, prostate cancer patients like Haller essentially had three treatment options. They could undergo surgery-called radical prostatectomy-to have the entire gland and the cancer within it removed. Patients might also choose radiation, delivered externally through beams, or internally through radioactive seeds that are implanted in the gland.

Finally, patients might opt to wait and see how aggressive the cancer was to see if treatment was necessary. The wait-and-see approach is most common among older men who might not tolerate treatment well, and for whom the cancer is likely to be less aggressive.

Now, men diagnosed with prostate cancer have an excellent fourth option to attack the disease. Called cryosurgery, the practice of freezing the gland to kill the cancer within it has been performed routinely for the last decade or so.

During the one- to two-hour procedure, physicians use special probes to deliver a freezing agent-typically argon gas-into the prostate gland. The freezing agent forms a lethally cold ice ball that freezes the prostate and the cancer cells in it.

Throughout the procedure, temperature monitors are used to allow physicians to determine when target temperatures have been reached. At that time, the freezing agent is stopped, leading to an instant thaw. The thawing process ruptures and kills the cells in the prostate gland. The freeze/thaw cycle is performed twice to ensure all the cancer cells are completely destroyed. During the procedure, a warming catheter protects the urethra from the freezing temperatures, reducing the risk of future incontinence.

Compared to prostatectomy-the surgical removal of the prostate gland-cryosurgery provides similar cancer control for low-risk prostate cancer. For moderate to high-risk cancer, cryosurgery results in equal or superior cancer control over traditional surgery.

In recent years, cyrosurgery has undergone striking improvements. "I first did cryosurgery in the early 1990s," says George Suarez, MD, a Miami, Florida, urologist. But Suarez stopped doing the procedure for a while, until about five years ago when he saw that dramatic improvements were made in the equipment used to perform the surgery.

The most critical of those improvements were better ultrasound technology and better software, Suarez says. The ultrasound enhancements allow surgeons to see the tumors and guide the probes to the correct spot within the prostate gland. Improved software means more accurate placement of the needles used to deliver the freezing agent.

Quality of Life

In addition to showing excellent clinical results, cryosurgery is considerably easier on patients than traditional surgery. Cryosurgery patients often have the option of local or general anesthesia, and either go home the same day, or remain in the hospital for just one night. Haller, for example, stayed overnight, but says he could have gone home the same day if he had not traveled from his Syracuse, New York, home to Rochester, New York, for the procedure.

The rate of long-term complications for cryosurgery patients is also promising. For example, the incidence of incontinence is lower for cryosurgery patients than it is for prostatectomy patients. Studies show impotence rates are higher among cryosurgery patients, but advances in ultrasound technology now allow physicians to precisely direct the freezing agent, and often avoid damaging the bundle of nerves responsible for sexual function.

"Today's patients are more informed-probably from all the information available on the Internet," says Dr. Suarez. He says the information they collect and consider makes their decisions more informed.

One of the things Dr. Suarez sees patients factoring into their decisions about treatment options is quality of life. "They want to be cured, but they don't want to compromise when it comes to issues like incontinence or impotence. They are as concerned about quality of life after the procedure," he says. That is why many patients, like Haller, choose cryosurgery.

Dr. Suarez also notes that cryosurgery is repeatable, if the cancer were to return, which gives patients a peace of mind the other treatment options cannot. Traditional surgery is not repeatable because the prostate gland has already been removed. Radiation cannot be performed again-for the treatment of any disease-because of the risk of damage to other tissues in the body.

Cost effectiveness and productivity gains

While the perception might be that traditional surgery is more aggressive in terms of treating prostate cancer than cryosurgery, Dr. Suarez says clinical data shows cryosurgery is equal to or better than prostatectomy in terms of cancer control.

And, compared to the relatively brief procedure cryosurgery patients undergo, traditional prostate cancer surgery is a longer procedure with the potential for more complications. Radical prostatectomy patients are usually in surgery for two to three hours, under general anesthesia. As with any surgical procedure, Dr. Suarez points out, prostatectomy poses the risk of blood loss and potential need for a blood transfusion, as well as the risk of infection.

Prostatectomy also involves a much longer recovery period. Traditional surgery is followed by a two- to three-day hospital stay, usually including some time in an intensive care unit. Surgery patients typically do not resume normal daily activities for three to five weeks.

Haller was able to resume normal activities within a few days. Because his construction industry job requires a lot of driving, awkward lifting and walking around potentially hazardous building sites, he did not return to work for nine weeks. Haller says he could have gone back to a desk job within three to four weeks of the procedure. When he did return to work nine weeks after the procedure, Haller says he was feeling 100 percent.

With the widespread availability and use of PSA testing, many more men are now diagnosed in the early stages of prostate cancer. The American Cancer Society estimates that in 2004 about 230,000 new cases of prostate cancer will be diagnosed in the United States.

For these men, cryosurgery offers an opportunity to destroy the cancer that threatens their lives without major surgery and the potential risks and complications it involves. It also means a quicker return to their normal lives, including for many, their jobs. For health care payers-the insurance companies and government programs that cover the cost of treatment-an equally effective, but less invasive procedure that involves a shorter procedure with less in-hospital recovery time, is also very promising.

Now, two years out from treatment, Haller could not be more pleased with his decision to opt for cryosurgery. "I have no doubt in my mind that the cancer I had is no longer there. For two years, every PSA I've had has been less than 0.1-not even a little spike," he says.

For the hundreds of thousands of men who face the devastating news of a prostate cancer diagnosis, cryosurgery offers hope that they can treat the disease quickly and effectively, with minimal disruptions to their lifestyle.