Cryotherapy for recurrent prostate cancer

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on cryotherapy for recurrent prostate cancer in May 2005.

Further recommendations have been made as part of the clinical guideline on prostate cancer published in February 2008, as follows:

High intensity focused ultrasound (HIFU) and cryotherapy are not recommended for men with localised prostate cancer other than in the context of controlled clinical trials comparing their use with established interventions.

Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from www.nice.org.uk/cg58. The IP guidance on cryotherapy for recurrent prostate cancer remains current, and should be read in conjunction with the clinical guideline.

Description

This procedure is used to treat carcinoma of the prostate that has been unsuccessfully treated via another method, most typically radiation or hormones.

The procedure is performed by inserting cryotherapeutic probes into the prostate gland.  These are used to freeze the gland along with cancerous tissue, thus destroying the diseased tissue.

Patients are typically given spinal anaesthesia. A warming catheter is inserted into the bladder, which is kept distended and warmed to 38º C and remains in place for two hours following the procedure. Cryoprobes are inserted into the prostate under transrectal ultrasonic guidance.

Thermocouples or temperature monitor probes are placed adjacent to the neurovascular bundles, the apex, Denonvilliers' space and external sphincter. A double freeze-thaw process is initiated with the anterior cryoprobes being activated first, followed by the posterior probes. The aim is to freeze the entire gland. A suprapubic tube is left in place and open for at least 4 days postoperatively.

 

NICE Pathways

This guidance has been incorporated into the following NICE Pathways, along with other related guidance and products.

Visit the NICE Pathway: prostate cancer

OPCS4.6 Code(s):

M70.8 Other specified other operations on outlet of male bladder

Y13.2 Cryotherapy to lesion of organ NOC

Z42.2 Prostate

In addition the ICD-10 code C61.X Malignant neoplasm of prostate or C79.8 Secondary malignant neoplasm of other specified sites would be recorded.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG119 Cryotherapy for recurrent prostate cancer: guidance (web format)	11 February 2011
	IPG119 Cryotherapy for recurrent prostate cancer - guidance	25 May 2005
	IPG119 Cryotherapy for recurrent prostate cancer - information for people considering the procedure	25 May 2005
	Interventional procedure consultation document - salvage cryotherapy for recurrent prostate cancer (second consultation)	26 October 2004
	Overview of salvage cryotherapy for recurrent prostate cancer (second consultation)	26 October 2004
	Interventional procedure consultation document - secondary transperineal cryotherapy for carcinoma of the prostate	30 March 2004
	Overview of secondary transperineal cryotherapy for carcinoma of the prostate	26 March 2004