Focal Cryotherapy in the Treatment of Localized Prostate Cancer

Huy D. Nguyen, BS; Bryan J. Allen, MD; Julio M. Pow-Sang, MD

Disclosures

Cancer Control. 2013;20(3):177-180. 

In This Article

Procedure

Cryotherapy is performed under anesthesia, with the patient in the lithotomy position through a transperineal percutaneous approach. A 7.5-MHz ultrasound probe is utilized for real-time visualization of the prostate and attached to an ultrasound probe stand secured to the surgical table. A mapping grid is placed close to the perineum attached to the ultrasound stand, and 17-gauge cryoprobes are introduced percutaneously into the area to be treated within the prostate gland under ultrasound imaging guidance. Temperature probes are placed in Denonvilliers' fascia, apex of the prostate, and external urinary sphincter to monitor temperature in these areas during the procedure. A flexible cystoscopy is performed, and a 0.038 semi-rigid guide wire is inserted, the cystoscope is removed, and a urethral warming catheter is placed over the guide wire. The procedure begins by delivering argon gas, and freezing of the area is monitored with ultrasound imaging. After adequate freezing is achieved, the thawing part of the procedure is then conducted using hydrogen gas. The process is repeated one more time. Once the procedure is completed, the cryoprobes, temperature probes, ultrasound probes, and urethral warmer are removed, and an 18 Foley catheter is inserted and left indwelling. The patient is discharged home on the day of the procedure, and the catheter is removed 1 week later.

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