Cryotherapy is a minimally invasive treatment that uses extreme cold to destroy prostate cancer tissue. It is primarily used for localized cases and may be suitable for patients who are not candidates for surgery or radiation therapy.
Although cryotherapy is less invasive than traditional treatments, it still carries risks and potential side effects. Knowing these factors can help you determine if this approach is appropriate for you.
This overview explains how cryotherapy works, who may be suitable candidates, the treatment process, and how it compares to other prostate cancer treatments.
What Is Cryotherapy for Prostate Cancer
Cryotherapy, or cryoablation, is a thermal ablation technique that destroys cancer tissue through controlled freezing.
Probes are inserted into the prostate and cooled with gases such as argon or liquid nitrogen to form an “ice ball.” This process causes ice formation, osmotic imbalance, and vascular damage, resulting in cell death in the targeted area.
Cryotherapy affects all tissues within the treatment zone, including healthy structures. However, focal cryotherapy techniques allow physicians to target specific cancerous regions, helping preserve more healthy tissue compared with approaches that treat the entire prostate gland.
For this reason, cryotherapy is mainly used in men with clinically localized prostate cancer, where the cancer is confined to a well-defined region of the prostate.
Even focal cryotherapy may affect nearby structures beyond the primary treatment area, increasing the risk of side effects such as urinary incontinence and erectile dysfunction.
Cryotherapy Eligibility and Patient Selection
Physicians examine several factors when determining whether cryotherapy may be appropriate, including the characteristics of the cancer, prostate anatomy, prior treatments, and a patient’s treatment goals.
Cryotherapy is most commonly considered in the following situations:
- Early-stage prostate cancer
- Targeted (focal) therapy or whole-gland treatment, depending on the case
- Locally recurrent prostate cancer that has returned after radiation therapy
Prostate cryotherapy is not suitable for everyone. Men with very large prostate glands or certain anatomical features may be less ideal candidates, since these factors can make treatment more challenging or increase the risk of side effects.
Because every prostate cancer patient’s situation is different, careful individual evaluation is essential when considering cryotherapy as a treatment option.
The Cryotherapy Treatment Process
Cryotherapy is typically performed as a minimally invasive, image-guided procedure and usually takes about 45 minutes. While details may vary between centres, the overall treatment process follows a similar sequence.
- Anesthesia and preparation
The procedure is performed under general or spinal anesthesia. A warming catheter is used to protect the urethra during treatment. - Probe placement and freezing
Cryotherapy probes are inserted into the prostate under imaging guidance, and controlled freezing cycles are applied to the targeted tissue. Warm saline is circulated through the catheter to help protect surrounding structures. - Recovery and discharge
After the procedure, patients are monitored for several hours and usually discharged the same day. A urinary catheter is typically left in place for one to two weeks to support urination during recovery and is removed at a follow-up visit. - Short-term recovery
Most patients return to normal activities within a few days. Temporary side effects such as mild discomfort, swelling, or blood in the urine or semen may occur but generally improve over time. - Follow-up and monitoring
Follow-up care includes regular PSA blood tests and clinical monitoring to assess treatment response.
Cryotherapy Prostate Cancer Side Effects, Risks, and Limitations
While cryotherapy is generally well-tolerated and less invasive than surgery, it involves extreme freezing of prostate tissue and carries both short-term side effects and longer-term risks that should be carefully considered. These include:
- Short-term local effects: Temporary soreness at probe insertion sites, scrotal or penile swelling, and blood in the urine are common during early recovery.
- Bladder or rectal irritation: Some patients may experience pain, burning, or discomfort in the bladder or rectum due to cold-related injury to nearby prostate tissues.
- Erectile dysfunction: Erectile dysfunction is a recognized long-term side effect of cryotherapy and can occur at relatively high rates due to freezing-related nerve damage.
- Urinary incontinence: Urinary incontinence is uncommon after primary cryotherapy but occurs more frequently when used as a salvage treatment after radiation therapy.
- Urinary retention and catheter dependence: Temporary difficulty emptying the bladder may occur due to prostate swelling after treatment, so short-term catheterization is commonly required during recovery.
- Infection and urinary symptoms: Other complications include urinary tract infections and symptoms such as urgency or a weak stream.
- Rare but serious complications: In rare cases, cryotherapy can cause rectourethral or rectovesical fistulas that may require surgical repair.
- Cancer control limitations: Higher local recurrence rates are a concern after focal cryotherapy, particularly in patients with more aggressive or locally advanced prostate cancer, and additional treatment may be required over time.
How Cryotherapy Compares to Other Prostate Cancer Treatments
Cryotherapy is one of several minimally invasive treatment options for prostate cancer. Below, we compare cryotherapy with other commonly used treatments to explain how they differ in their mechanisms of action, potential risks, and situations where one option may be weighed differently than another.
Alternative Prostate Cancer Treatments →
Cryotherapy vs HIFU (High-Intensity Focused Ultrasound)
Both cryotherapy and HIFU treat prostate cancer by destroying targeted prostate tissue using thermal energy, but they rely on opposite approaches. Cryotherapy destroys cancer cells by freezing them, while HIFU uses focused heat.
In selected patients, cancer control outcomes for cryotherapy and HIFU are broadly similar. However, cryotherapy often involves a larger treatment margin, especially in whole-gland or salvage settings, which may increase the risk of affecting surrounding structures compared to more targeted heat-based approaches.
Both options are thermal treatments and share risks associated with temperature-induced tissue destruction, including potential damage to nearby structures that can result in urinary incontinence or erectile dysfunction.
Cryotherapy vs CyberKnife Radiation Therapy
Cryotherapy and CyberKnife differ fundamentally in their approach. Cryotherapy destroys cancer cells by freezing prostate tissue, while CyberKnife uses highly focused radiation to target and kill cancer cells.
A key distinction is that CyberKnife uses ionizing radiation, which can lead to cumulative exposure. This may influence treatment planning, especially for patients who wish to avoid radiation or preserve future local treatment options if recurrence occurs.
As a result, some patients may prefer cryotherapy over CyberKnife to avoid radiation exposure and maintain flexibility for future local treatment. However, cryotherapy remains a thermal treatment and carries limitations related to temperature-based tissue damage.
Cryotherapy vs TULSA-PRO
Cryotherapy and TULSA-PRO are both minimally invasive, image-guided treatments that use temperature to destroy prostate tissue, but vary in how treatment is delivered.
Cryotherapy involves placing multiple probes through the perineum to freeze targeted areas of the prostate, while TULSA-PRO delivers ultrasound energy through a device in the urethra to heat and destroy prostate tissue.
Because TULSA-PRO uses a transurethral approach, treatment may be more limited in patients with larger prostate glands or certain tumour shapes. Both approaches carry a risk of affecting surrounding structures, depending on tumour location and treatment extent.
Non-Thermal Alternatives to Cryotherapy for Prostate Cancer
While most alternatives to cryotherapy use thermal ablation or ionizing radiation, our non-thermal treatments use electrical currents to eliminate cancer cells. By avoiding thermal injury, these therapies aim to treat cancer while protecting quality of life.
Minimally Invasive Prostate Cancer Therapies →
Irreversible Electroporation (IRE)
Irreversible Electroporation (IRE) is a non-thermal treatment that applies brief electrical pulses to destroy prostate cancer cells without heat or freezing. By disrupting cancer cell membranes instead of using temperature extremes, IRE is designed to preserve the structural integrity of surrounding tissue, including nerves and blood vessels.
Because it avoids thermal injury, IRE is associated with lower rates of urinary and sexual side effects. At VITUS Private Clinic, clinical experience has shown 90–95% preservation of potency and 100% preservation of continence in more than 2,000 treated patients.
In addition to its gentler profile, IRE delivers broader eligibility than many thermal therapies. It may be used for localized and intermediate-risk prostate cancer, as well as selected advanced or recurrent cases, including metastatic recurrences.
Electrochemotherapy
Electrochemotherapy for prostate cancer is another non-thermal treatment that combines electroporation with targeted chemotherapy delivery. Electrical pulses temporarily open cancer cell membranes, allowing chemotherapy agents to enter tumour cells more effectively.
Because the drug is delivered directly to the tumour, substantially lower chemotherapy doses are required. This reduces the systemic side effects and toxicity typically associated with conventional chemotherapy.
In selected cases, electrochemotherapy may be combined with irreversible electroporation (IRECT) to treat advanced or recurrent prostate cancer, including disease involving sensitive surrounding structures such as the sphincter, rectum, or bladder wall.
Electrochemotherapy and IRECT for prostate cancer are currently offered exclusively at VITUS Private Clinic.
Immunotherapy
The immune system plays an important part in identifying and controlling prostate cancer cells that spread beyond the prostate. Immunotherapy for prostate cancer supports this process by strengthening the immune system’s ability to recognize and respond to cancer cells.
A challenge with prostate cancer is that tumours are often considered immunologically “cold,” meaning the immune system does not easily recognize them. For immunotherapy to be effective, tumour-specific antigens must be released in a way that allows immune activation.
Thermal treatments such as cryotherapy destroy tissue through extreme cold, which can damage these tumour antigens. In contrast, non-thermal treatments such as irreversible electroporation, electrochemotherapy, and IRECT destroy cancer cells without heat, allowing tumour antigens to remain intact and support a more effective immune response.
Considering Alternatives to Cryotherapy?
At VITUS Private Clinic, we focus on minimally invasive, non-thermal prostate cancer treatments designed to reduce collateral tissue damage, preserve urinary and sexual function, and support the body’s natural immune response as part of comprehensive cancer care.
If you are considering cryotherapy or exploring other treatment options, our team can review your case and help determine whether approaches such as irreversible electroporation, electrochemotherapy, or immunotherapy-supported treatments may be a more appropriate approach.
Contact VITUS Private Clinic to request a personalized case review and discuss your treatment options.
Call us now on +49 (0)177 23 82 863 or get in touch using the contact form
Frequently Asked Questions
Cryotherapy is used as a localized prostate cancer treatment in selected patients. It destroys cancerous tissue by controlled freezing and may be performed as a focal treatment targeting specific tumour areas or as whole-gland therapy in some instances. It is most often considered when surgery or radiation therapy is not suitable.
Cryotherapy may be appropriate for men with localized prostate cancer confined to the prostate. Candidates commonly have low- to intermediate-risk disease, tumours that can be accurately targeted with imaging, and prostate anatomy suitable for probe placement. It may also be considered after radiation therapy failure.
Cryotherapy involves inserting thin probes into the prostate under imaging guidance. These probes circulate extremely cold gases to freeze targeted tissue, forming an ice ball that destroys cancer cells. The procedure is performed under general or spinal anesthesia, with measures in place to protect surrounding structures.
Side effects after cryotherapy most commonly involve urinary and sexual function. Temporary urinary symptoms and swelling are common during recovery, while erectile dysfunction is a recognized long-term risk due to freezing-related nerve injury. The likelihood of side effects depends on the extent of treatment and the tumour location.
Cryotherapy is typically performed as an outpatient procedure. Most patients return to normal daily activities within a few days, although a temporary urinary catheter is usually required for one to two weeks. Mild swelling, discomfort, or urinary symptoms may occur during early recovery and generally improve over time.
If cryotherapy is not appropriate, non-thermal focal treatments such as Irreversible Electroporation (IRE) or Electrochemotherapy may be considered. These approaches destroy cancer cells without heat or freezing. They are designed to reduce damage to surrounding nerves and blood vessels, which may help preserve urinary and sexual function in selected patients.