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Surgery and radiation therapy remain the standard treatment for localized prostate cancer, but other, less popular treatment options might be beneficial as well. As time goes on and the benefits of these treatment options are further explored, it’s possible that they will move more into the mainstream. For now, though, none are seen as standard treatments for localized prostate cancer.

Cryotherapy

Cryotherapy, also known as cryosurgery or cryoablation, has been around for years, but until a few years ago, it was rarely used. With this approach, probes are inserted into the prostate through the perineum (the space between the scrotum and the anus), and argon gas or liquid nitrogen is delivered to the prostate, literally freezing to death the prostate cells and any prostate tumors. (Review the roles of the prostate and the surrounding organs in the About the Prostate section.)

Over the years, a number of modifications were made to avoid freezing damage to the nearby structures, but the rates for both erectile and urinary dysfunction remain high, and data on long-term outcomes are limited.

Cryotherapy is also used as a secondary local therapy in men who underwent radiation therapy as initial treatment for early-stage prostate cancer. Note that men with more well-confined disease tend to fare better, while those who received hormone therapy in addition to radiation therapy tend to fare worse. Side effects of this focal therapy include further urinary or sexual problems such as urinary stricture, erectile dysfunction, and urgency. Rarely, cryotherapy can result in injury to surrounding tissues such as the rectum or bladder given the proximity of these structures to the prostate bed.

High-Intensity Focused Ultrasound

High-intensity focused ultrasound, or HIFU, works in exactly the opposite way compared with cryotherapy: with HIFU, the prostate cells are heated to death. A probe is inserted into the rectum, from which very high-intensity ultrasound waves are delivered to the target area. Although this technique remains experimental in the United States, it’s been used in Europe for a number of years with a fair amount of success. Side effects of HIFU are similar to those discussed above for cryotherapy and depend on the skill and experience of the surgeon using this technique.

Primary Hormone Therapy

Hormone therapy, also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent the hormone from acting on the prostate cells. (A review of common hormone therapy strategies can be found in the Hormone Therapy section.)

Although there is little, if any, data to show that hormone therapy alone is an effective treatment strategy for men with localized prostate cancer, it is increasingly being used in this setting. Because it is not invasive, it is possible that the therapy is seen as a middle ground between active surveillance and local therapy. For men who are not good candidates for surgery or radiation, and who require immediate therapy, primary hormonal therapy is a reasonable option. However, as stated above, hormonal therapy has a long list of side effects as well that are not desirable, and thus, the main question is whether in these men who are not candidates for immediate surgery or radiation, therapy can be safely deferred. Primary hormonal therapy is also a reasonable option in men who start off with metastatic disease (cancer spread beyond the prostate). In these men, hormonal therapy will shrink the prostate gland and cancer and delay any need for local therapies for many men.

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