Cryotherapy in Prostate Cancer Periprocedural Care

Updated: Jul 24, 2020
  • Author: Matthew R Cooperberg, MD, MPH; Chief Editor: Edward David Kim, MD, FACS  more...
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Periprocedural Care

Preprocedural Evaluation

A preprocedure prostate-specific antigen (PSA) test is important for assessing risk and establishing a baseline from which the PSA level can be tracked after treatment. Other preprocedure laboratory studies include the following:

  • Urine culture

  • Complete blood cell (CBC) count with platelet count

  • Coagulation tests (ie, prothrombin time [PT] and activated partial thromboplastin time [aPTT])

Cryoablation is performed under the guidance of transrectal ultrasonography (TRUS). In addition, a TRUS scan is required before the cryoablation procedure, for the following reasons:

  • To plan treatment

  • To assist in clinical staging by identifying any hypoechoic or hypervascular lesions (as well as extracapsular extension or seminal vesical involvement)

  • To estimate the prostate volume

  • To identify any large transurethral resection defect

In most cases, TRUS has already been performed to obtain the prostate biopsy specimen by which the disease was diagnosed.

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Equipment

Modern third-generation cryotherapy systems such as Galil and CRYOcare use small, needle-shaped probes, which can be placed percutaneously, under TRUS guidance, directly into the prostate.

Older systems used relatively large cannulas, which necessitated a more complex technique: 6 hollow, diamond-tipped, 18-gauge needles were placed transperineally under TRUS guidance in the anteromedial, posterolateral, and posteromedial regions of the prostate. A 0.038 J-tip guide wire was passed through each needle; the needle was removed, the tract was dilated over the wire, a 12-French cannula was placed, and the wire was removed.

Computer software systems are under development that are likely to facilitate both preoperative planning and real-time monitoring of progression of therapy. [69]

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Monitoring and Follow-up

Cryotherapy is usually performed in an outpatient setting. A urethral catheter is left in place for 3 weeks after treatment to minimize the likelihood of tissue sloughing and urinary retention. Urinary retention after cryotherapy commonly develops as a consequence of local urethral edema. Some investigators have left the urethral warming catheter in place for several hours after the procedure in an attempt to minimize injury to the urethra, [9] but this maneuver has not been well studied.

After cryotherapy, routinely evaluate the patient to assess for the development of late complications and to look for symptoms or signs of clinical recurrence. Monitor the PSA level at regular intervals.

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