Ice cold gas that kills prostate cancer and cuts the side-effects

DAVID TALLANT, 68, a grandfather and retired carpenter from Poole, Dorset, had his prostate cancer treated with a freezing procedure, as he tells CHLOE LAMBERT.

Ten years ago, I used to go sailing with a guy who’d had prostate cancer, and he urged me to have a PSA test. It measures the levels of a protein produced by the prostate gland.

I had no symptoms, but surprisingly when my GP did the test it came back a little high. Anything more than four is considered raised for my age group — mine was eight or nine.

A biopsy confirmed prostate cancer. It was a shock, but they told me they’d caught it early and it hadn’t spread outside the prostate. I was offered surgery to remove the prostate or radiotherapy. I went for the radiotherapy. That seemed to do the trick, and with my PSA levels going back to normal, they declared me clear.

I continued to have an annual PSA test and all was well until last year, when it was high again — about six.

I had noticed I was going to the loo more often, which I knew could be a sign of trouble. The prostate is wrapped around the urethra — the pipe carrying urine out of the body — and a tumour can put pressure on this pipe.

A biopsy confirmed the cancer was back. Again, it had been caught early, but my consultant said more radiotherapy was out of the question. The healthy tissue surrounding the cancer would have been affected by the first lot so any more would cause serious damage.

I could have had hormone therapy with drugs to lower my testosterone levels and slow the growth of the cancer, but my doctor told me about Mr Dudderidge in Southampton, who is treating nHS prostate cancer patients with a procedure called cryotherapy.

Mr Dudderidge kindly saw me and did some MRI scans and a mapping biopsy: this involved him taking tissue samples from the prostate and combining these with ultrasound scans to work out which areas needed treating.

We talked about a treatment called highintensity focused ultrasound (HIFU), which kills cancer with sound waves, but Mr Dudderidge said I had calcium buildup on my prostate.

This is not uncommon in men my age and is harmless — apparently, there’s calcium throughout our bodies and it can accumulate on the prostate as you get older and as a result of infections.

But the calcium would deflect So the HIFU sound waves.

In my case, cryotherapy would be more effective. The treatment involves freezing the tumour with very cold gas, which make the cells crack open and die.

I knew there were possible sideeffects, including incontinence and erectile dysfunction, but having been through prostate cancer once already, and bowel cancer five years ago, I felt early intervention and treatment was the only way to go.

If they didn’t get all the cancer, they could perform the treatment again, unlike radiotherapy. I had the procedure at the end of June. It took about two hours under general anaesthetic and I could go home by the end of the day.

I had a bit of discomfort, and for the following week I had a catheter, but I’ve endured worse.

About two weeks after the treatment I had an MRI scan, which showed that the prostate cancer had been destroyed.

I’ll now have PSA tests every three months and another scan in a year’s time. I think I made the right decision.

THE SURGEON

Tim DuDDeriDge is a consultant urological surgeon at Southampton general Hospital. IF YoU put a bottle full of water in the freezer, as the fluid freezes and expands, the container will crack. This is the basis of cryotherapy — we repeatedly freeze and thaw cancerous cells using chilled gas, causing them to crack and die.

Cryotherapy is not new. It is commonly used to treat skin cancer and abnormal cells on the cervix. Using it on the prostate i sn’t new either, but the technology has been refined so we can deliver more targeted treatment, known as focal cryotherapy.

The key difference is that the needles we use to apply the f reezing gas have become finer, and using argon gas rather than liquid nitrogen gives us better control over the temperature.

Imaging techniques have also improved, meaning we can accurately map the area that needs treating.

That’s important, because prostate cancer cells can appear in clusters and also because of the location of the prostate.

If you treat the wrong area, then the patient can suffer sideeffects such as incontinence and erectile dysfunction.

In 30 per cent of patients treated with radiotherapy, the disease recurs. It’s not possible to give further radiotherapy because the neighbouring tissues will have suffered damage.

Further treatment means a risk of bleeding and fistulas — where a passage f orms between the bladder and rectum and urine starts draining into the rectum.

operating to remove the prostate is extremely challenging after radiotherapy because the tissue doesn’t heal so well. You can end up with leakage and injury to the rectum. Many men whose prostate cancer has returned after radiotherapy are just put on hormones and not told it’s possible to treat the disease. But there are options.

We think cryotherapy and another recent development, HIFU, have a real role to play.

Unlike radiotherapy, they can be used again if the treatment isn’t successful the first time because they don’t cause irreversible changes in the surrounding healthy cells. Cryotherapy is especially useful for patients who, like Mr Tallant, aren’t suitable for HIFU.

After taking a biopsy and MRI scan to work out where to target the treatment, the patient comes in for day surgery.

With the patient under general anaesthetic, we insert fine needles into the prostate, using the MRI images as guidance. We insert a catheter into the urethra and pass through a warm saline solution to protect the area and stop the cells there freezing.

We then pass compressed argon gases through the needles into the prostate. These cool rapidly to minus 40c and develop into balls of ice on the ends of the needles.

After ten minutes of freezing, we run helium through the needle to warm up and thaw the ice ball. Typically, we run through two AFTeRWARDS, freezing and thawing cycles.

the patient may feel as if they want to use the l oo because the bladder will be a little irritated.

The urethra swells up, too, so we leave the catheter in for about a week as it recovers.

There is a small chance of damage to the urethra, causing scarring and narrowing, which means the patient will notice their urine stream reducing. We can sometimes use gentle dilators to improve the problem.

The main risk with any procedure on recurrent prostate cancer is a fistula, which can cause infection. However, the risk is only 3 per cent, or lower if the cancer is at the front of the prostate.

In this situation we would put a catheter into the bladder to ensure urine is passed out of the body to stop an infection. Then, things often heal on their own.

If not, the patient would need a reconstructive operation, which would be pretty serious.

ANY DRAWBACKS?

PRoFeSSoR Roger Kirby, a prostate surgeon and trustee of Prostate Cancer UK, says: ‘Cryotherapy is especially applicable in men where radiotherapy has not eradicated their cancer, or where the cancer has recurred.

‘But patients need to be warned there are risks, including a fistula, which is a difficult thing to correct and can, in some ways, be worse than having cancer.’

THe procedure costs £8,000 to the NHS and £10,000 privately. it is available at several centres in the uK. Patients with localised prostate cancer can ask to be referred by their consultant or gP.