Cryotherapy as a primary treatment for prostate cancer

NICE interventional procedures guidance [IPG145] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on cryotherapy as a primary treatment for prostate cancer in November 2005.

Further recommendations have been made as part of the clinical guideline on prostate cancer published in February 2008, as follows:

High intensity focused ultrasound (HIFU) and cryotherapy are not recommended for men with localised prostate cancer other than in the context of controlled clinical trials comparing their use with established interventions.

Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from www.nice.org.uk/cg58. The IP guidance on cryotherapy as a primary treatment for prostate cancer remains current, and should be read in conjunction with the clinical guideline.

  • Description

    Cancer of the prostate gland may cause it to enlarge, resulting in symptoms such as difficulty in urinating, frequent urination, and blood in the urine. The risk of prostate cancer rises with age and it is rare in men younger than 50.

    Treatment options depend on the stage of the cancer. Current treatments for localised prostate cancer include watchful waiting, radiotherapy, and radical prostatectomy.

    Cryotherapy may be performed under general or spinal anaesthesia. A warming catheter is inserted into the urethra, to prevent it being damaged by the cold. Cryoneedles or probes are inserted into the prostate, under radiological guidance. Temperature monitor probes may also be placed percutaneously through the perineum. Argon gas or liquid nitrogen is then circulated through the needles or probes generating very low temperatures and causing the formation of ice around the prostate gland, which destroys the tissue. Newer cryotherapy techniques allow for these needles to be removed or repositioned so that the frozen zone conforms to the exact size and shape of the target tissue.

  • OPCS4.6 Code(s)

    M70.8 Other specified other operations on outlet of male bladder

    Y13.2 Cryotherapy to lesion of organ NOC

    Y53.- Approach to organ under image control

    Z42.2 Prostate

    Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

    In addition the ICD-10 code C61.X Malignant neoplasm of prostate is assigned.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding

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