Cryotherapy for Cancer Treatment
Cryotherapy is a minimally invasive ablative treatment using extreme cold to destroy cancer tissue, with established roles in prostate cancer (as an alternative for low- and intermediate-risk localized disease in patients unsuitable for surgery/radiation) and cervical precancerous lesions, though it is NOT recommended as standard care for high-risk prostate cancer outside clinical trials. 1, 2
Prostate Cancer Applications
Primary Treatment Indications
Cryotherapy may be considered for low- and intermediate-risk localized prostate cancer specifically in patients who:
- Cannot undergo radical prostatectomy due to morbid obesity, prior pelvic surgery, or significant comorbidities 2
- Have contraindications to radiotherapy 2
- Have life expectancy >10 years despite comorbidities 2
Oncologic Efficacy by Risk Group
- Low-risk disease: 96.4% biochemical progression-free survival with cancer-specific survival of 98.1% 3
- Intermediate-risk disease: 91.2% biochemical progression-free survival, with similar outcomes to non-dose escalated external beam radiation therapy plus neoadjuvant hormonal therapy 2, 3
- High-risk disease: Only 62.2% biochemical progression-free survival; cryotherapy is NOT recommended outside clinical trials for this population 1, 3
Critical Limitations and Caveats
The AUA/ASTRO/SUO guidelines provide only a conditional recommendation (Evidence Level Grade C) due to:
- Paucity of randomized controlled trials (only two RCTs exist, both comparing to EBRT) 2
- Insufficient long-term mortality data 2
- NCCN does not recommend cryotherapy as routine primary therapy 2
Expected Adverse Effects
Patients MUST be counseled that erectile dysfunction is an expected outcome, not a potential complication:
- Erectile dysfunction: 47-100% (essentially universal with whole-gland treatment) 2
- Continence maintained: 95% of patients 2
- Incontinence: 1.3-19% 2, 3
- Urinary obstruction: 1.9% 3
- Prostatorectal fistula: 0.9% 3
- Perineal pain: 11.1% 3
Cryotherapy produces worse sexual side effects than radiotherapy but maintains better continence than radical prostatectomy. 2
Salvage Therapy Role
Cryotherapy serves as a salvage option after radiation therapy failure:
- Biopsy of the prostate after radiation should only be performed in men being considered for salvage local therapy including cryotherapy 1
- Salvage cryotherapy may offer disease control without systemic toxicity of androgen deprivation therapy 4
Technical Requirements
Third-generation or higher argon-based cryosurgical systems with temperature monitoring using thermocouples should be utilized:
- Systems with temperature monitoring: 71-89% progression-free survival 2
- Systems without temperature monitoring: only 17-28% negative biopsies post-treatment 2
Cervical Cancer/Precancerous Lesions
Cryotherapy is an established treatment for cervical precancerous lesions with:
- Cure rates: 56.8-96.6% in prospective controlled trials and 70-95.5% in observational studies 5
- Extremely rare serious complications affecting reproductive outcomes 5
- High patient acceptability with temporary, self-limited side effects (vaginal discharge, cramping) 5
- Superior cost-effectiveness and feasibility for low-resource settings compared to LEEP 5
What Cryotherapy Is NOT Recommended For
Cryotherapy should NOT be used for:
- High-risk localized prostate cancer outside clinical trials 1
- Primary treatment when radical prostatectomy or radiotherapy plus ADT are feasible options for high-risk disease 1
- Patients seeking preservation of erectile function 2
Common Pitfall to Avoid
Do not confuse "cryotherapy" with other ablation techniques (radiofrequency ablation, microwave ablation, irreversible electroporation) - these are distinct modalities with different mechanisms, indications, and outcomes. 6 Clear documentation of the specific technique is essential for clinical communication. 6