Cryotherapy for Localized Prostate Cancer

Cryotherapy for localized prostate cancer is one of a growing number of therapies for localized prostate cancer. I am a long-term survivor of an incurable blood cancer called multiple myeloma. Experience has taught me that each of us has our own priorities and goals. After all, all therapies have strengths and weaknesses.

The list of pros and cons is designed to help you make choices based on your priorities.

While the video linked below is somewhat technical, I have chosen it to provide potential PCa patients with as much information as possible.

Cryotherapy for Prostate Cancer

Cryotherapy (also called cryoablation or cryosurgery) is a minimally invasive treatment for localized prostate cancer that destroys cancer cells by freezing them. It is typically used for men with low- to intermediate-risk prostate cancer, and sometimes as salvage therapy if radiation fails.

Below is a balanced, evidence-based breakdown of the pros and cons.

Pros of Cryotherapy for Localized Prostate Cancer

1. Minimally Invasive Procedure

Performed using thin probes inserted through the perineum (skin between the scrotum and anus).
Usually outpatient or short hospital stay.
Less blood loss than prostatectomy.
Faster recovery compared to surgery.

👉 Many men resume normal activity within days to a few weeks.

2. Option for Patients Who Cannot Have Surgery

Cryotherapy can be beneficial for:

Older patients
Men with significant comorbidities
Patients who want to avoid major surgery

3. Can Be Repeated

Unlike radiation, cryotherapy can often be repeated if cancer returns.
Can also be used as salvage therapy after radiation failure.

4. Lower Immediate Systemic Side Effects

No systemic toxicity like chemotherapy.
Less fatigue and general illness compared with radiation or systemic treatments.

5. Potential for Focal Therapy

Some centers perform focal cryotherapy, freezing only the cancerous portion of the prostate.

Potential benefits:

Reduced side effects
Better preservation of urinary and sexual function
Increasing interest in precision oncology

6. Good Cancer Control in Selected Patients

Studies show:

5-year disease-free survival rates:
Low risk: ~80–90%
Intermediate risk: ~60–80%

(Results vary widely depending on patient selection and physician experience.)

Cons of Cryotherapy for Localized Prostate Cancer

1. High Risk of Erectile Dysfunction

This is the most common complication.

ED rates:
Whole-gland cryotherapy: 40–80%
Focal cryotherapy: lower but still significant

Nerve damage occurs because freezing affects surrounding neurovascular bundles.

2. Urinary Side Effects

Possible complications include:

Urinary incontinence (less common than surgery but still possible)
Urinary retention
Irritative urinary symptoms
Sloughing of prostate tissue
Rare but serious: urethral stricture

3. Limited Long-Term Data Compared to Surgery or Radiation

Cryotherapy has:

Good short- and medium-term results
Less 15–20 year survival data than radical prostatectomy or radiation therapy

This creates uncertainty about long-term cancer control.

4. Risk of Incomplete Cancer Destruction

Because freezing patterns may be uneven:

Some cancer cells may survive
PSA monitoring after treatment can be difficult to interpret

5. Rare but Serious Complications

Uncommon but important risks include:

Rectourethral fistula (connection between rectum and urethra)
Infection
Pelvic pain or nerve injury

6. PSA Monitoring Becomes Less Clear

Unlike prostatectomy, where PSA should drop to near zero:

PSA can remain detectable after cryotherapy
Makes recurrence detection more complex

Ideal Candidates for Cryotherapy

Most guidelines suggest best outcomes in men with:

Localized prostate cancer
Small to moderate prostate size
Low- or intermediate-risk disease
Patients not ideal for surgery or radiation
Radiation recurrence with localized disease

Patients Who May Not Be Good Candidates

Very large prostate gland
Extensive or high-risk cancer
Cancer near the urethra or rectum (higher complication risk)
Severe urinary symptoms before treatment

Cryotherapy vs Other Treatments (Quick Comparison)

Treatment	Invasiveness	ED Risk	Incontinence Risk	Long-Term Data
Surgery	High	Moderate-High	Moderate	Strong
Radiation	Moderate	Moderate	Low-Moderate	Strong
Cryotherapy	Low	High	Low-Moderate	Moderate
Active Surveillance	None	None	None	Depends on monitoring

Integrative Oncology Considerations

(You often write about these topics.)

Some supportive approaches under investigation after cryotherapy include:

Anti-inflammatory diet
Exercise to improve metabolic health
Microbiome support
Stress-reduction interventions
Supplements such as omega-3s, curcumin, or vitamin D (evidence varies)

As I mentioned above, I am a long-term cancer survivor myself. I produce PeopleBeatingCancer in an effort to educate cancer patients about both therapies as well as the short-term, long-term and late-stage side effects that patients need to know about.

Scroll down the page, post a question or comment and I will reply to you ASAP.

Good luck,

David Emerson

Cancer Survivor
Cancer Coach
Director PeopleBeatingCancer

Focal Cryotherapy in Prostate Cancer. Does Gleason Impact Results?

Abstract

Purpose: Focal cryotherapy is a minimally invasive treatment for localized prostate cancer (PCa), but its oncological outcomes, particularly in relation to baseline Gleason Grade Group (GG), remain understudied. This study evaluates its efficacy and the impact while radical of baseline Gleason score on recurrence-free survival.

Materials and methods: A retrospective analysis included 111 patients with localized PCa treated with focal cryotherapy between 2014 and January 2024. Patients with prior treatments or follow-up < 12 months were excluded. All patients underwent MRI and transperineal biopsy, and cryotherapy was performed using the Visual ICE Cryoablation System. Confirmatory biopsies were recommended at 12-24 months post-treatment. Recurrence was classified as either in-field (treated or adjacent areas) or out-field (non-adjacent areas). Any recurrence-free survival was defined as the absence of positive biopsy or additional treatment. Radical treatment-free survival was defined as the absence of whole-gland treatment (e.g., radical prostatectomy, radiotherapy), androgen deprivation therapy, metastasis, or death. Outcomes were compared between patients with baseline GG 1 and GG >1.

Results: Median follow-up was 35 months (IQR 24-49). Confirmatory biopsies were performed in 78% of patients (n=87), revealing in-field recurrence in 10% and out-field recurrence in 23%. There were no statistically significant differences between ISUP 1 and ISUP >1 groups in terms of protocol biopsy positivity for either in-field recurrence (HR 0.41; 95% CI 0.09-1.9) or out-field recurrence (HR 0.77; 95% CI 0.3-1.98). At three-years, the rates of any recurrence-free and radical treatment-free survival were 63% and 85%, respectively, with no significant variation by baseline GG.

Conclusion: Focal cryotherapy provides favorable short-term oncological outcomes in localized PCa, with no significant differences in recurrence-free survival based on baseline Gleason score.

Cryotherapy for localized prostate cancer Cryotherapy for localized prostate cancer