Cryotherapy - Prostate Cancer Charity

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Treatment Specialist Nurses 0800 074 8383 prostatecanceruk.org 4 When you have your catheter removed at the hospital it may be uncomfortable, but it should not be painful. You will need to stay for a few hours after the catheter has come out to check that you can pass urine without difficulty. You may wish to take some spare underwear and spare pair of trousers with you. In some centres your doctor or nurse may arrange for you to have your catheter removed at home. You may see some blood in your urine, both while the catheter is in and after it has come out. This is normal, and you should drink plenty of fluids to help clear the blood. If you are worried about it at all, contact your doctor or nurse for advice. You may also have some bruising and swelling of the skin around the testicles (scrotum), buttocks and inner thigh in the few weeks after the procedure. Your doctor or nurse may advise you to avoid long periods of standing for the first few weeks. You should be able to go back to your day-to-day activities as soon as you feel able to, although it may take a few weeks or months before you feel back to normal. What happens afterwards You will have follow-up appointments with your doctor or nurse at the hospital to check your recovery and monitor your response to the treatment. Your prostate specific antigen (PSA) level will be monitored regularly to help check how well the treatment has worked. How often will vary depending on the treatment centre, but you should have a PSA test about every three months for at least the first year, and every six months after that. You can ask your doctor or nurse how often you will have a test. If you had cryotherapy as a first treatment and your cancer starts to grow again, you may be able to have more cryotherapy. In some cases you may be offered radiotherapy or, rarely, surgery. If you had cryotherapy as a second treatment and your cancer starts to grow again, you will be offered hormone therapy. You can find more information about treatment options after cancer has come back in our booklet, Recurrent prostate cancer: A guide to treatment and support or you can call our Specialist Nurses on our confidential helpline. What are the side effects Like all treatments, cryotherapy can cause side effects. <strong>Cryotherapy</strong> will affect each man differently, and you may not get all of the side effects. The most common side effects include erection problems (see below) and urinary problems (see page 5). Many of the side effects of the treatment are caused when healthy tissues are frozen and damaged. There is a greater risk of side effects if you have already had radiotherapy or brachytherapy to treat prostate cancer. This is because these treatments may have already caused some damage to the tissues surrounding the prostate gland. Short term side effects Short term side effects include: • blood in the urine (haematuria) • difficulty or discomfort passing urine • bruising and swelling of the penis, skin around the testicles (scrotum), inner thigh and the area between your testicles and back passage (perineum), or • pain and bleeding where the needles were inserted. Mid or long term side effects Erectile dysfunction The most common long term side effect is difficulty getting or keeping an erection (erectile dysfunction). This is because the nerves responsible for erections can be damaged by the treatment. More than three quarters of men (over 75 per cent) will be unable to get an erection following cryotherapy. If sex is important to you, you should discuss with your doctor or nurse whether cryotherapy is a suitable treatment for you. Some men will find that they gradually get back their erections but for most men this is likely to be a long term problem. We do not know for
Treatment Specialist Nurses 0800 074 8383 prostatecanceruk.org 5 sure how many men will get their erections back. There are medical treatments available which may be helpful and you can discuss these with your doctor of nurse. Our Tool Kit fact sheet, Sex and prostate cancer gives more information on treatments for erectile dysfunction. If you are planning to father children in the future, it might be possible to store your sperm before having cryotherapy. Speak to your doctor or nurse. Urinary problems <strong>Cryotherapy</strong> can cause urinary problems including leaking urine (urinary incontinence) and having a weak or slow flow of urine. These problems usually improve with time. Up to one in twenty men (five per cent) who have cryotherapy as a first treatment will find that they leak urine to some degree. This is more likely if you have cryotherapy as a second treatment and affects up to one in six men. For some men this may improve with time. However for some men the problem will be long term and you may have to wear pads in your underwear either temporarily or permanently. Making some changes to your lifestyle, such as doing pelvic floor muscle exercises may help to improve urinary problems or make them easier to manage. You can read about these in our Tool Kit fact sheet, Pelvic floor muscle exercises. A recent study found that about four in every hundred men who had cryotherapy as a first treatment had a weak or slow flow of urine after treatment. This is more likely if cryotherapy is a second treatment, affecting up to one in five men. The problem can be caused by swelling of the prostate gland and may pass in time. In a small number of cases a weak or slow flow of urine can be caused by damage to the tube that carries urine out through the penis (urethra). Small pieces of dead tissue are passed through the urethra (urethral sloughing) and may cause a blockage, making it difficult or impossible to pass urine. This can affect up to three out of every 100 men (three per cent) who have cryotherapy. Having a catheter for a short while may ease the problem or if necessary you can have an operation to help this. There is also a small risk that the urethra may become narrowed (stricture) after treatment. This will also cause a weak or slow flow of urine. Some men may need to have a procedure in hospital to help with this. Speak to your doctor or nurse if you are having difficulty passing urine. You can read more about urinary problems and possible treatments in our Tool Kit fact sheet, Urinary problems after prostate cancer treatment. Bowel problems A small number of men may get a complication where a hole forms between the back passage (rectum) and the tube which carries urine through the penis (urethra). This is known as a fistula, and is rare in men having cryotherapy as a first treatment. It is more likely, though still uncommon, if you have had an earlier treatment for prostate cancer which may have damaged the wall of the back passage. It can affect up to two out of every 100 men (up to two per cent). Fistulas can develop up to several weeks after cryotherapy. Sometimes pain and infections of the urethra can be early signs of a fistula, although these can also be caused by something else. Contact your doctor or nurse if your urine is strong smelling or you have a temperature, which could be signs of an infection. Discharge from the urethra or back passage or diarrhoea may also be signs of a fistula. If you develop a fistula, you will need to have an operation to repair the hole. Pain It is normal to experience some pain or discomfort after having cryotherapy. This can be managed with pain-relieving drugs and your doctor or nurse should tell you which you can take. However some men will have pain that lasts for a few weeks or months. The pain may be in the area in or around the penis, testicles and back passage. There is a greater risk of pain if you have had another treatment before cryotherapy. Antibiotics may help and the pain will usually improve. Speak to your doctor of nurse if you have any pain.
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