Cryo is a Greek word and means "cold." When you choose cryo to kill cancer tumors, it means you will use a very cold temperature - 40 degrees F. Actually, it isn't the cold that kills the cells. It's the very rapid thawing process following the freeze cycle. But more on that later. Most cryo procedures consist of 2 consecutive freeze and thaw cycles.

          1. Patients with low risk Gleasons have a 92% successful cancer kill.

          2. Patients with medium risk Gleasons are 89% successful.

          3. Patients with high risk Gleasons are also 89% successful!

This data is available. Call 1-877-722-2796 (1-877-PCA-CRYO). Ask for their brochure PM-21552 Rev-B

3. Cryo is not a very invasive procedure. It is sometimes done on an outpatient basis but normally it's a 24 hour visit to a hospital. You are on your way home the next day and usually back to work within a couple of days. Some of the recovery stories are truly remarkable!

4. Cryo can be repeated if your PSA should rises and the residual cancer is still within the capsule.

5. Cryo is the procedure of choice for men who have failed radiation procedures.

6. Cryo is not an expensive procedure. It is FDA approved and Medicare will pay for it.

WHAT'S POSSIBLY BAD ABOUT CRYO?

Two huge "quality of life" or  "downside baggage" issues for all procedures are incontinence and erectile dysfunction (also called impotence).

Incontinence means you wet your pants. This may be controlled with pads, diapers, Depends, external clamps, more surgery or medication. Wetting your pants is very demeaning and makes you ashamed and embarrassed about what happened.

Erectile dysfunction or impotence means you can't get it up like you did before.  "Roscoe don't want to play no more." No more sex. Bummer! However, there are ways to improve the situation with Viagra, injection, implants, slings or your fist, etc. These subjects are covered elsewhere on this web site.

Neither of these unfortunate situations threatens your life … but it's difficult to convince a man and his family that it isn't a huge, nasty problem! Believe us, it will play head games with everyone.

A NEGATIVE FACT. If cancer tumors are in close proximity to the urethra (located in the transitional zone) you CAN NOT USE CRYO because you can't freeze the urethra.

CRYO and INCONTINENCE

 For prostate cancer survivors, incontinence seems to be a more urgent concern than impotence. If you're wearing a pad and it fills to overflowing, it becomes obvious to anyone who sees you …or smells you.

Based upon numbers of procedures performed, the radical prostatectomy is "king of the hill" with various radiation procedures, (including seeds) a close 2nd. Understandably, the promoters of those procedures and not particularly enthused seeing the rapidly growing acceptance of "newcomer cryo" providing such good tumor kill data.

The same data also shows cryo has very low incontinence rates. The rate for radicals is many times higher …the highest of all the procedures! The various radiation procedures are quite low immediately following the procedure but increase dramatically 5-7 years later.

There is a huge difference of opinion as to how bad a patient's incontinence really is. In the opinion of the doctors performing the procedures, they say it is not a severe problem. When the reported data come from the men who are wetting their pants, there interpretation of their discomfort and shame is dramatically worse than the doctor's view.

CRYO and IMPOTENCE

(Note - some of the clinical data my be changed. I'm waiting for updated information.)

Having sex and a good erection are high on list of good things both men and women remember. As we age, that importance gradually diminishes, but for many, the memories and urges linger on.

From the clinical study data indicated earlier, here are the figures showing the likelihood you will have some degree of impotence problems from the 3 general categories of procedures:

          Cryo                                                  22 - 95%

          Radical                                             14 - 90%

          External beam or                               6 - 84%

          Conformal radiation therapy

          Seeds                                                0 - 66%

1. The first conclusion is that seeds seems to offer the best odds of keeping you smiling, particularly if you hope to remain sexually active and are a younger man.

2.  The second conclusion is that no one should be proud of any of first three lines of data. The chances that …"Willie will smile again" are just about slim to none.

NERVE SPARRING PROCEDURES

TO PREVENT IMPOTENCE

For a number of years, doctors have been performing "nerve sparring radicals" for carefully selected patients. It is not appropriate for many men because of their diagnosis. The nerves that create an erection are very tiny and fragile and are located in direct contact with the outside surface of the prostate capsule. It is an extremely delicate procedure and requires great skill to surgically remove the prostate capsule without damaging those nerves. Depending upon where the tumors are, sometimes only one set of nerves can be saved and the rest go out with the gland. Even when a man is considered a good risk for nerve sparring, there is only a 50% chance of success.

NERVE SPARRING FOR CRYO PATIENTS

For the past several years, some doctors have been performing a cryo version of the radical's nerve sparring technique. Dr. Onik of Orlando, FL who developed the technique has named his procedure the "Male Lumpectomy" after the women's breast cancer lumpectomy.

To qualify for the procedure, a man's cancer must be definitely confined to one side of the capsule. To determine this, the patient is put under anesthesia and the entire prostate gland is thoroughly biopsied. Biopsies are all taken 10mm apart from any nearby biopsy over the entire capsule. That is a lot of biopsies! The side of the gland that does not have cancer will NOT be frozen. In addition, special heating elements are placed next to the erection nerves for additional protection to the nerves on that side.

There is an unexpected feature of the cryo nerve sparring concept …if your PSA should eventually rise at a later date because there actually was some cancer in the side that wasn't frozen, you can have another cryo procedure and get it the second time around! This can't be done with any other procedure!

LET'S DESCRIBE THE CRYO PROCEDURE

PREPARING YOU FOR THE PROCEDURE (See the diagram - trying to get something from Endocare - the main freezing equipment people.)

Most men have a general anesthetic but some have a local. You will lie on your back with your feet in stirrups just like a lady having a baby.  The procedure takes place in the area of your crotch between your anus and the rear of your scrotum sack that containing your testicles. (The crotch area is called the perineum.)

1. The doctor inserts a rubber tube warm water catheter into your urethra from the tip of your penis, up through the penis shaft, the prostate and into the bladder. This is called the "urethral warmer." A second catheter is inserted into the bladder through your pubic area. (The urethra is your piping that normally carries urine. The pubic area is just above the hair above your shaft.) During the freezing procedure, warm water will flow through the urethral warming catheter to keep the urethra from freezing. You will need your urethra to pee through for the rest of your life. The water passing through the warming catheter discharges from the bladder through the catheter exiting from the pubic area.

2. Warm water will also be put into the rectum during the actual freezing process to protect it from freezing. (This WAS a big problem in the very early days of cryo but is essentially non-existent now.)

All the remaining steps of this discussion utilize a Grey Scale Ultrasound probe. The ultrasound probe is about 6 - 8" long and about ¾" in diameter. It is lubricated with KY jelly and inserted through your anus into the rectum. When pressed against the wall of the prostate, the doctor can "virtually see" the inside the entire prostate on a TV screen. This allows the doctor to precisely place the temperature sensing wires and freezing probes.

GETTING READY FOR THE ACTUAL FREEZING PROCESS

The doctor will place a number of temperature sensing wires called thermocouples through the crotch into the prostate. These temperature probes will measure critical temperatures within the gland during the freezing process.

The freezing probes are very thin, double hollow tubes about 12" in length and 3 mm in diameter. Only about 3 - 4" of the probe actually is inside the body. Six to eight probes will all be in the prostate at the same time. There will be Argon gas circulating within the probes. This is what causes things to get cold and freeze. NO, you don't have any gas bubbling around in your belly!

4. The freezing probes are inserted through the crotch area into the prostate gland with ultrasound probe guidance. The desired location has already been determined (mapped) prior to the operation. Some cryo surgeons (usually the older "artists") prefer to insert the probes "free hand" into the desired portions of the gland. Younger doctors seem to prefer a computer-controlled system with a template to place the probes similar to the seeds implant concept.

The prostate gland is about the size of walnut. You can imagine how crowded it is in that walnut sized gland with a number of thermocouples and 6 - 8 freezing probes!

STARTING THE ACTUAL FREEZE

Everything is set! Warm water is flowing through the urethral warmer and the grey scale ultrasound probe (TRUS - Trans Rectal Ultra Sound) has been inserted into your rectum and shows a picture on the TV screen. Warm water has been put into the rectum. Let's make an ice cube out of your prostate gland and kill some cancer!

Your gland is at body temperature and the computer controlled freezing procedure begins to slowly let Argon gas circulate through the freezing probes. At the tip of each probe a small tear dropped shaped ice pellet begins to form from the moisture in the prostate gland touching the tip of the cold probe.

Gradually, the size of each ice pellet grows in size and there are 6 - 8 of the probes inside that little walnut sized gland … it's pretty crowded! As the ice pellets enlarge, they begin to coalesce (bond together) into a single ice cube … but there is no freezing close to the urethra.

The TRUS probe CAN NOT see through the thickness dimension of the ice cube but it CAN SEE unfrozen gland material, the capsule wall and the OUTSIDE EDGE of the ice ball being formed. This outside edge shows as a thin white line in the Grey Scale TV picture. During this entire process, the computer program draws a graph of all the critical temperatures being measured as they drop lower and lower and the ice ball increases in size.

BACK TO MAKING THAT ICEBALL!

We will now continue our description of the cryo procedure and explain how it handles the potential problem of positive margins. If the tumors were just barely through the capsule …perhaps ¼" or less, then cryo has a solution to the problem. If the tumors are further outside the capsule wall, not even cryo can get it.

The cryo doctor intentionally allows the iceball to pass through the capsule wall about ¼". He can see the thin white line on his TV screen and he stops the freezing. Actually, he has been slowing down the rate of freezing as the iceball approached the capsule wall.

When the growth of the iceball has been stopped outside the gland, it will be held at that temperature for some predetermined length of time.

Two points to understand:

1. There is only about ½" - ¾" of fatty tissue between the outer wall of the capsule and the rectum. The warm water in the rectum keeps it from freezing … and we surely don't want to freeze it because that causes a "fistula" (a hole in the rectum) and that is not good. It is now a very, very rare occurrence with the current freezing technology.

2. Because the cryo doctor put killing, low temperatures on those little bits of tumors that had just "ooched" through, they too will soon be "dead tumors."

NOW WE KILL THE TUMORS!

Back in the second paragraph of this discussion we said:

"Actually, it isn't the cold that kills the cells. It's the very rapid thawing process following the freeze cycle … but more on that later." Well, "later" is" now."

Intense cold does not necessarily kill cells. Consider sperm banks, stem cell research, samples from fertility banks … all of them are stored for long periods of times at temperatures many, many times colder than the -41 degrees F of your frozen prostate. They will live again because they are very carefully and slowly thawed.

The operative words are "slowly thawed." We want your prostate cells to die and this is accomplished by rapidly thawing them. When the Argon freezing gas is turned off, it is replaced by lots of warmed Helium gas. In a relatively short period of time (a matter of minutes), the gland is rapidly warmed to somewhere around body temperature. This sudden thawing causes the membrane of every frozen cell to rupture, resulting in their immediate death. There is no tomorrow, nothing, nada, zilch. They are history!

Compare that to all the radiation procedures. The death of cells from radiation can be anywhere from hours to many, many months. And surviving cells tend to come back in a more aggressive form!

PLAY IT AGAIN, SAM.

The first freeze and thaw cycle has been completed. A second freeze/thaw cycle will now be done. Sometimes, the location and depth of insertion of the probes will be changed to cover different parts of the gland.

GET READY TO GO UPSTAIRS TO RECOVERY AND THEN HOME THE NEXT DAY.

When the 2nd freeze/thaw cycle is completed, all the apparatus is removed and a catheter is inserted through the tip of the penis into the bladder so you can pee. You will wear the catheter for around a week. Some men say wearing the catheter may the hardest part of the whole procedure. A small price to pay!

You will be in recovery for about an hour and then back up to your room. You soon will be up walking around the floor with your urine bag hanging from a portable dolly. You should be on your way home in the morning …about 24 hours after you arrived. Unless you do hard, physical labor, you will probably be back to work in a couple to 3 days. Ain't you glad you had cryo?