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 for recurrent prostate cancer in May 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 NICE guideline CG58. The IP guidance on cryotherapy for recurrent prostate cancer remains current, and should be read in conjunction with the clinical guideline.
This procedure is used to treat carcinoma of the prostate that has been unsuccessfully treated via another method, most typically radiation or hormones.
The procedure is performed by inserting cryotherapeutic probes into the prostate gland. These are used to freeze the gland along with cancerous tissue, thus destroying the diseased tissue.
Patients are typically given spinal anaesthesia. A warming catheter is inserted into the bladder, which is kept distended and warmed to 38º C and remains in place for two hours following the procedure. Cryoprobes are inserted into the prostate under transrectal ultrasonic guidance.
Thermocouples or temperature monitor probes are placed adjacent to the neurovascular bundles, the apex, Denonvilliers' space and external sphincter. A double freeze-thaw process is initiated with the anterior cryoprobes being activated first, followed by the posterior probes. The aim is to freeze the entire gland. A suprapubic tube is left in place and open for at least 4 days postoperatively.