Cryotherapy for prostate cancer

Cryotherapy involves inserting needles into your prostate and freezing the cancer cells. There’s more information in the section ‘what happens during cryotherapy’. 

Cryotherapy is a type of focal treatment. In focal treatment, we only treat the area of your prostate affected by cancer. If some areas of your prostate have very slow-growing cancer, we may not treat them right away. Instead, we watch these areas closely and treat them if the cancer grows or changes. 

Cryotherapy may be an option if you have localised prostate cancer. That means that the cancer has not spread beyond your prostate. Cryotherapy is not suitable if the cancer has spread outside your prostate.

The benefits of having cryotherapy include: 

• It may cure the cancer.
• You do not need to have cuts. So, it’s gentler on your body than some other prostate cancer treatments.
• You will either go home the same day or stay in hospital for one night.
• You will have few side effects.
• Your recovery will be short so that you can soon return to normal daily living.

The risks of cryotherapy for prostate cancer include: 

• Erections problems. Cryotherapy can sometimes affect the nerves that create erections. This happens to 12 in 100 men who had good erections before cryotherapy. In most men, this usually starts to resolve after three months, but it may be permanent for some. NHS treatments such as tablets and injections can help, though they are not always effective.  
• Urine leaks. This is also called urinary incontinence. Urine leaks happen to 1 in 100 men and normally improve three months after cryotherapy. Some men wear pads to protect their underwear. We can teach you pelvic floor exercises to reduce urine leaks.  
• Fistula. This is a hole between your rectum and urethra. Your urethra is a tube that carries urine from your bladder to the tip of your penis. During cryotherapy, a part of your rectum may also be frozen and can get damaged. This happens to less than 1 in 700 men. Although rare, it is serious, and you may need an operation to repair the hole. You may also need to use a stoma. A stoma is a bag worn on the outside of your body to collect your poo.  
• There are also some risks linked to having general anaesthetic. You can visit the Royal College of Anaesthetists website for more information.

This depends on whether your prostate cancer is low-risk or high-risk. Your hospital doctor will explain which risk group you are in. If you’re not sure, you can ask your doctor or CNS to explain it to you. 

If you have low or medium-risk prostate cancer

You may not need treatment right away. Instead, we can monitor it with active surveillance for 5 to 10 years. This means you will have regular tests to check the cancer. If there are signs that your cancer is progressing, we will offer you treatment.  

At UCLH, 1 in 3 men with low to medium-risk cancer needed treatment after five years. Some men choose treatment right away because they feel uneasy waiting. However, studies show that survival rates are very similar whether you have treatment now or later.   

Note: If your cancer is very low-risk and doesn’t show on an MRI scan, treatment may not be an option. 

If you have a high-risk prostate cancer

If you choose not to have cryotherapy or another treatment, there is a risk that the cancer could grow or spread. Delaying treatment might mean it is no longer an option later. And going without treatment could pose a serious risk to your life. 

If you choose not to have cryotherapy, other treatments may be available. Your hospital doctor or CNS will tell you about them. We have more information about them on our treating prostate cancer web page. 

There isn't a "best" treatment for localised prostate cancer. That’s because each treatment has advantages, disadvantages and side effects, and affects men differently. You may not experience all the possible side effects. Consider how the side effects may impact your daily life before choosing a treatment. Your healthcare team is here to support you to make the best choice for your needs and lifestyle.

Pre-assessment appointment

We will give you a pre-assessment clinic appointment several weeks before your cryotherapy. At the appointment, the nurse will check if you are well enough for the treatment and will: 

• Explain the anaesthetic you will have. 
• Tell you if you should continue taking your medicines. 
• Let you know when to stop eating and drinking before cryotherapy. 
• Advise what to bring on the day.

Plan your travel home

Arrange for someone to take you home after your cryotherapy and stay with you overnight. If you don’t have someone to take you home, you will need to stay in the hospital overnight. It’s ok to use public transport if you need to. 

Arrange to have your catheter removed

You will have a urinary catheter (tube) placed in your bladder during cryotherapy to drain urine. This will stay in place for three to seven days.  

We prefer you to have your catheter removed at UCLH. But if you’d like it done closer to where you live, contact your GP surgery to arrange this before your cryotherapy. You should arrange this before as some local services may not offer catheter removal. If you haven’t arranged it before your treatment, you will have your catheter removed at UCLH.

We want to involve you in all the decisions about your care and treatment. If you choose to have cryotherapy, by law we must ask you to sign a consent form before you have it. This confirms that you agree to have cryotherapy and understand what it involves. Staff will explain the risks, benefits and alternatives before you sign a consent form. If you are unsure about cryotherapy, please tell your hospital doctor or CNS.

Having cryotherapy is similar to having a transperineal prostate biopsy. Cryotherapy takes about two hours. 

Before cryotherapy

• A nurse gives you an enema one to two hours before the cryotherapy. An enema is a liquid which is placed into your rectum to help to empty it. This makes sure we can get a clearer ultrasound image during cryotherapy. 
• We give you a general anaesthetic which means you will be asleep during cryotherapy.  

During cryotherapy

• During cryotherapy, a surgeon inserts special needles through your perineum into your prostate. Your perineum is the area between your rectum and scrotum.  
• The surgeon puts an ultrasound probe into your rectum. They take ultrasound images of your prostate to check that the needles are in the correct place.

© Cancer Research UK [2002] All rights reserved. Information taken 24/02/2025 

• The surgeon puts argon gas through these needles, making them very cold. The temperature of the needles may be as low as -40°C. This freezes the prostate and destroys the cancer cells.
• The surgeon checks the temperature in and around your prostate using special needles.
• The surgeon inserts a narrow ‘warming’ tube into your urethra. This stops your urethra being damaged when they freeze your prostate.

Straight after cryotherapy

• After cryotherapy, the surgeon inserts a catheter through your penis into your bladder. This is to help your urine drain. It stays in place for five to seven days. Sometimes we insert a catheter through your tummy into your bladder instead.

• You will stay in the day surgery unit until you are fully awake and have eaten and drunk something. You may feel some discomfort in your rectum and penis. Mild painkillers like paracetamol or ibuprofen usually help. Tell your nurse if you are still in pain and they can give you stronger painkillers.  
• You may also be given tablets to relax your prostate. These are called alpha-blockers, such as tamsulosin or alfuzosin.   
• Before you go home:
  1. We will show you how to empty and care for your catheter. 
  2. We will give you antibiotics to take for three to five days to prevent infection. 
  3. We will give you a contact number in case you have any problems at home. 
  4. Ask for a medical certificate if you need one.  
  5. Make sure you have your appointment for your catheter removal. 

You can usually go home the same day as the procedure, if you have someone to go with you. If you don’t have someone to take you home or if you have certain medical conditions, you may need to stay in the hospital overnight.

• Difficulty peeing. You will have a catheter fitted during cryotherapy to stop this. If you had other treatments before cryotherapy, it might take longer for you to pee normally. Your doctor and CNS will discuss this with you before your cryotherapy. 
• Tingling or numbness around your penis. This usually goes away within two to four months.  
• Blood in your urine or semen, or from your rectum. This normally goes away in six to eight weeks. 
• Pain. It is normal to feel some discomfort where the surgeon inserted the needles. This should normally go away in one to two weeks. We recommend you get paracetamol and ibuprofen to take at home if they are suitable for you. We can prescribe you stronger painkillers if you need them. You can also ask your GP to prescribe these. Please always follow the instructions on the packet. If you are unsure how or when to take them, please contact your CNS. 
• Bleeding. You may have slight bleeding in the area between your rectum and scrotum. Put a dry dressing on it if this happens. If the bleeding is heavy: 
  • contact your hospital doctor or CNS. 
  • or go to your nearest Emergency Department (A&E). 
• Bruising and swelling. You may develop some bruising in the area between your rectum and scrotum. You may also get some swelling of your scrotum or penis. This will get better without any treatment over a couple of months. 
• Tiredness. This is normally caused by the general anaesthetic and should get better after a few days. 

Most people recover from cryotherapy within one to two weeks. Most people return to work once their catheter is removed. Some people have longer off work, depending on their job. Please ask for a sick note (fit note) before you are discharged, if you need one.

• Drink 1.5 to 2 litres of fluid each day. This will stop you from becoming dehydrated, constipated or getting a urine infection. Drink lots of fluids for six to eight weeks after cryotherapy.
• Avoid constipation. Constipation might cause you to strain when you poo and could lead to blood loss. We will give you a gentle laxative syrup when you leave the hospital to ease constipation. We will give you instructions on how much and how often you should take this. The laxative softens your poo making it easier to pass. Avoid constipation for six to eight weeks after cryotherapy.
• Keep your skin between your rectum and scrotum clean and dry. You should not need a dressing in this area once you leave the hospital.

First 24 hours

Let your urine drain freely into the catheter bag (leg bag). At night, you can attach a larger night bag. 

After 24 to 48 hours

You no longer need to let your urine drain freely into the bag. Instead, you can let it collect in your bladder. To do this: 

• Detach the leg bag from the catheter and attach a catheter valve.  
• If the valve is already fitted, remove the leg bag from the valve.  
• When the valve is off (up position), your bladder will fill with urine.
• When you feel the need to pee, open the valve to empty the urine into the toilet.  
• Close the valve again once you have emptied your bladder.  

Caring for your catheter

You can find detailed instructions on our Caring for your urinary catheter web page. Ask your CNS or ward nurse if you’d like a paper copy of the information. 

Tips for draining urine

Emptying your bladder through the catheter valve can cause your bladder to collapse onto the catheter, which can be painful. To avoid this:  

• Open the valve slowly and let the urine drain gently.  
• Stop draining when you feel your bladder is empty. 
• Close the valve before it becomes uncomfortable.

We will check how well your bladder empties once we remove the catheter in the clinic. We call this the ‘Trial WithOut Catheter’ or ‘TWOC’ clinic. This appointment is usually arranged for five to seven days after your cryotherapy. You will normally be in the department for three to four hours for this appointment.  

If you prefer to have the catheter removed nearer to where you live, contact your GP surgery to arrange this. You must arrange this before your cryotherapy as it may not be available at all local hospitals and GP surgeries. You will get a UCLH TWOC clinic appointment if you have not arranged to have the catheter removed elsewhere.

After cryotherapy, your GP and hospital must monitor you. Although many men are cured after cryotherapy, some may need further treatments.

Follow-up appointment

After your cryotherapy, we’ll give you an appointment to see the surgical team. The appointment will be three months after cryotherapy. The surgeon will ask if you have any problems peeing or getting erections. Please tell them if you notice any issues. You can also contact your CNS at any time to discuss these problems. We will offer you support or treatment if you need it.

PSA tests

You will need regular PSA (prostate-specific antigen) blood tests after cryotherapy. 

Your PSA levels will be checked regularly to monitor your recovery. We expect your PSA levels to go down after cryotherapy. The amount of reduction can vary for each person. 

• First PSA test: 3 months after cryotherapy. 
• First year: Every 3 months.  
• After 1 year: If stable, every 6 months. 

We will give you a PSA level to watch for. If your PSA goes above this level, contact us so we can review your care. We will ask you to provide a urine sample through your GP to check for infection. We’ll then ask you to repeat the PSA test 6 weeks later. We will not make a decision on your care based on a single result.  

You will have yearly telephone appointments with your hospital doctor or CNS to discuss your PSA results. 

MRI scans

You may have an MRI scan 10 to 14 days after cryotherapy to check for any issues. The surgeon will tell you if you need one on the day of your cryotherapy. 

Please note: There is no routine appointment to discuss the results. Your doctor will go over them with you at your follow-up appointment three months after cryotherapy. 

All patients have MRI scans at: 

• 1 year after treatment. 
• 3 years after treatment. 
• 5 years after treatment. 

You will have an appointment to discuss the results of these scans.

Other monitoring

We will monitor you for any urine or erection problems, and offer you support or treatment as needed. If you have trouble with your erections or urine symptoms, contact your hospital doctor or CNS for help.

We hope this information is helpful. If you have any questions, please ask your hospital doctor or CNS.

Prostate cancer treatments choices  

A video developed by North Central and East London Cancer Alliance to help you learn about prostate cancer treatments. 

UCLH Macmillan Support and Information Service 

020 3447 8663 (general enquiries) 

020 3447 3816 (support and information helpline)   

They provide: 

• Emotional support, advice and information 
• Welfare and benefits advice 
• Complementary therapies 
• Diet and nutritional advice 
• Psychological and emotional care 
• UCLH Prostate Cancer Support Group is held on the 2nd Thursday of each month, from 12.30pm to 2.30pm. You can attend either online or in person. Email uclh.supportandinformation@nhs.net for more information. 

Prostate Cancer UK 

0800 074 8383  

Provides support and information for patients and their families.

Macmillan Cancer Support 

0808 808 00 00  

Provides information and support to anyone affected by cancer.  

Cancer Research UK  

Provides information about prostate cancer and treatments. 

Infopool. Prostate Cancer Research  

The infopool has been co-designed with healthcare professionals and patients. Supporting patients and healthcare professionals with a new educational website. 

Squeezy app  

Support with pelvic floor muscles. Includes exercise videos. 

Your Pelvic Floor  

Information on pelvic floor exercises. 

5K Your Way – Move Against Cancer  

This program invites anyone affected by cancer – patients, loved ones, and cancer care workers—to take part in a 5K Your Way parkrun. Whether you want to walk, jog, run, cheer, or volunteer, you’re welcome to join on the last Saturday of each month. 

UCLH cannot accept responsibility for information provided by other organisations. 

Prostate Clinical Nurse Specialists (Mon – Fri, 9am to 5pm) 

Tel: 07984 391126 

Email: Uclh.prostatecancercns@nhs.net 

Pathway Coordinator for admin queries (for example changing your appointment) (Mon – Fri, 9am to 5pm) 

Tel: 020 3447 9194 

Email: Uclh.prostate.focal@nhs.net 

Out of hours, please contact your GP or go to your nearest Emergency Department (A&E).