Cryotherapy vs Other Treatments
Is Cryotherapy for you?
 It is not easy to choose a treatment for prostate cancer with the many options available today.
The choices for localized prostate cancer treatment include:
- Radical Prostatectomy
- Cryotherapy
- External Beam Radiotherapy (EBRT)
- Brachytherapy
- High Intensity Focused Ultrasound (HIFU)
If your prostate cancer is localised to the prostate then you may benefit from Cryotherapy treatment.
Your decision should be based upon discussions with your Urologist (Specialist in this field).
Cryotherapy in Comparison with other Treatments
1. Cryotherapy compared with Radical Prostatectomy
| |
Cryotherapy |
Radical Prostatectomy |
| Treatment
Description |
1½ hour minimally invasive (needles inserted) procedure in which the prostate is frozen but not removed. |
2-3 hour procedure to remove the prostate with abdominal incision. |
| Recovery |
Single Day Surgery procedure. Resume normal lifestyle in 2-3 days. |
Usually 5 days in hospital followed by a 3-5 week recovery. |
| Incontinence |
0% - 3% |
5% |
| Impotence |
20% - 80% |
15% - 90% |
| Rectal Injury |
1% |
1% - 3% |
| Efficacy |
Based on five and seven year published studies of PSA outcomes, cryotherapy and surgery provide similar cancer control for low risk prostate cancer. For moderate and high-risk disease, cryotherapy may provide superior cancer control over surgery. ¹ |
Based on five and seven year published studies of PSA outcomes, cryotherapy and surgery provide similar cancer control for low risk prostate cancer. For moderate and high-risk disease, cryotherapy may provide superior cancer control over surgery. ¹ |
2. Cryotherapy compared with Radiation Therapy
| |
Cryotherapy |
External Beam Radiation Therapy (EBRT) |
Brachytherapy |
| Treatment
Description |
1½ hour minimally invasive (needles inserted) procedure in which the prostate is frozen but not removed. |
7-8 week treatment where radiation is aimed at the prostate but also passes through healthy tissue. |
Permanent implantation of 80-100 radioactive pellets into the prostate. |
| Recovery |
Single Day Surgery procedure. Resume normal lifestyle in 2-3 days. |
5 treatments per week for 7-8 weeks at Radiation Centre. Up to six weeks of tiredness (longer if hormone therapy also used). |
Overnight stay procedure. Up to 3 months of residual pain and bowel symptoms. |
| Incontinence |
0% - 3% |
0% - 12% |
0% - 17% |
| Impotence |
20% - 80% |
5% - 85% |
0% - 65% |
| Rectal Injury |
1% |
12% - 15% |
5% - 20% |
Randomised controlled trial of External Beam Radiotherapy vs. Cryotherapy
A randomised controlled trial occurs when a Doctor is testing to see whether a treatment works because the operation or radiation or medication is effective because of the way it works or through chance or luck. It is done to show that a treatment actually makes a difference and the patient would not have had the same result by just waiting to see what happens.
It is carried out by giving a group of patients as much information as we know about the treatments that are being tested including the expected benefits, side-effects and risks of the treatment compared with not having any treatment. The patients then consent to being in this trial (experiment). The patients are then randomly selected for the treatment (either treatment A or treatment B) by placing their names in a hat (for example) and then allocating a treatment based on that. In this way the Doctor or patient is not biased toward a particular treatment and we can truly find out if something works or not. If, after a short time, it appears that a treatment is no good and causes harm, the trial may be abandoned so that the conclusion is that the experimental treatment does not work.
In a randomised controlled trial comparing External Beam Radiation Therapy as primary treatment with Cryoablation in localised prostate cancer carried out by Donnelly et al¹ it was concluded that at three years the results from EBRT are marginally better (EBRT 85.8% vs. Cryo 82%) but at the end of four years the results from Cryotherapy show somewhat greater improvement (EBRT 74.6% vs. Cryo 80.1%). Overall the results for control of the primary malignancy can be regarded as equivalent (see Table).
Random Control EBRT vs. Cryoablation (Primary Therapy)²
| |
Hormone Therapy |
3 Years |
4 Years |
Death* |
Failure** |
| EBRT |
√ |
85.5% |
74.6% |
4 |
32 (26%) |
| Cryo |
X |
82% |
80.1% |
5 |
25 (20%) |
¹ Long JP, Bahn D, Lee F, Shinohara K, Chinn DO, Macaluso JN Jr.,: Five-Year Retrospective, Multi-institutional Pooled Analysis of Cancer-Related Outcomes After Cryosurgical Ablation of the Prostate. Urology 57 (3): 518-523, 2001.
² Donnelly BJ, Saliken JC, Brasher P, Ernst S, Lau H, Trypkov K A randomised controlled trial comparing external beam radiation and cryoablation in localized prostate cancer. JUrol 2007; 117:376-377. AUA meeting abstract #1141.
* Death from Prostate Cancer.
** ASTRO (American Society for Therapeutic Radiology and Oncology) defines failure as PSA nadir + 2ng/ml increase.
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