Cryosurgery, also known as cryotherapy, is a surgical procedure in which probes are inserted into the target tissue and cooled to very low temperatures to destroy the tissue. It can be used to treat conditions such as prostate cancer among various other applications in urology including genital warts and kidney cancer.
The procedure is typically performed using a device that uses liquid nitrogen or argon to freeze the target area. The cells disintegrate as the frozen water crystals inside the cells break the cell walls during cryotherapy.
Possible complications of this procedure include infection, scarring, and damage to nearby healthy tissue. It is important to discuss the potential risks and benefits of cryosurgery with your healthcare provider and if it is the right treatment option for you.
How Are Cryosurgery and Erectile Function Related?
Erectile dysfunction is the most common side effect of cryosurgery; it is more common after cryosurgery than following radical prostatectomy, affecting as many as 80 to 90% of men who undergo the procedure. As per a 2010 study published in Nature Reviews Urology in which researchers compared the rates of erectile dysfunction in men who underwent cryosurgery versus external beam radiation therapy (EBRT), the following was concluded:
a) Among 56 men in the cryosurgery group, 62% were able to have unassisted intercourse prior to the procedure compared to 22% at 36 months after undergoing the procedure.
b) Among the 57 men in the EBRT group, 55% were capable of unassisted intercourse before treatment compared to 36% at 36 months after EBRT.
This suggests that cryosurgery may be associated with a higher risk of erectile dysfunction compared to EBRT radiation. It is important for men who are considering cryosurgery to understand the potential risks and benefits of the procedure, including the risk of erectile dysfunction.
Focal Cryoablation, an experimental procedure which is an alternative to total gland ablation may be helpful in minimizing the risk of ED after cryosurgery. Unfortunately, it is not widely available.
Reasons Cryosurgery Affect Erectile Function
This process of freezing prostate gland can potentially damage the nerves near the prostate that are necessary for an erection to occur, leading to an increased risk of erectile dysfunction (ED) after the procedure. Some studies have found that the risk of ED after cryosurgery is higher than after radical prostatectomy. Additionally, men who have had previous radiation therapy before undergoing cryosurgery may be more likely to experience ED than those who receive cryosurgery as their first line of treatment.
Why Cryosurgery is NOT the best option for healthy younger men with prostate cancer
Younger men with localized prostate cancer have the best chance for a cure with Robotic Radical Prostatectomy (RALP) performed by an experienced robotic urologist. Long term data shows that surgical removal of the prostate provides the best chance of long term cure in young men with localized high grade prostate cancer compared to radiation or cryosurgery.(Huang, et al and Wallis et al., European Urology, 2015)
The key word is “experienced” robotic surgeon, as that is what translates into, better outcomes with respect to cancer control, urinary control and maintenance of erectile function. The other side of the coin which is highly relevant is that prior radiation therapy or crysurgery mitigates against good outcomes with prostatectomy if the cancer were to recur, which is a likely possibility if radiation or cryosurgery are chosen as the initial options by younger men with high grade prostate cancer or if the prostate is large.
The carry home message would be to not ‘burn your bridges’ with sub-optimal interventions, but rather do your due diligence and find an expert, experienced robotic urologist to use the gold standard of treatment for early stage prostate cancer, Robotic Radical Prostatectomy (RALP).