Prostate cryoablation

A treatment that destroys prostate cancer by freezing it with thin needle-like probes placed through the skin between the scrotum and the anus, guided by ultrasound. It can treat the whole prostate or only the area with cancer.

Also called Cryotherapy, Cryosurgery, Prostate cryotherapy, Cryoablation of the prostate, Focal cryotherapy, Focal cryoablation, Salvage cryotherapy, Freezing the prostate

Where: Hospital or outpatient surgery center
Anesthesia: General or spinal anesthesia
Time in the room: About 1.5 to 2.5 hours
Hospital stay: Same day or one night
Going home with: Urinary catheter, through the penis or the lower belly, for about 5 days to 2 weeks
Back to normal: About 1 to 2 weeks
Back to work: About 1 week for desk work

See the steps

ProstateTumorRectumUrethraSphincter muscle

Where it happens. The highlighted part is what this procedure treats.

Overview

Cryoablation kills cancer cells by freezing them. Thin probes are placed into the prostate through the perineum, the skin between the scrotum and the anus. Gas flowing through the probes chills their tips far below freezing, and an ice ball grows around each one. Cells inside the ice ball are destroyed by ice crystals and by loss of their blood supply.

Each area is usually frozen and thawed twice, because a second freeze destroys cells more reliably. A warming catheter runs warm fluid through the urethra to protect it, and small temperature sensors near the rectum and the sphincter help the team keep the ice where it belongs.

Cryoablation can treat the whole prostate or only part of it. Whole-gland freezing usually affects erections, because the ice reaches the nerves on both sides; focal freezing spares more. It is also one of the main options when cancer comes back in the prostate after radiation.

Guidelines list cryoablation as an option for selected men. Long-term cancer results are less well studied than for surgery or radiation, so men who choose it need regular PSA tests and often MRI and biopsy afterward.

The parts of your body involved

The prostate sits below the bladder with the rectum directly behind it and the perineum below. The urethra runs through its middle, the urinary sphincter sits just below it, and the erection nerves run along its sides. Cryoablation places probes from the perineum and shapes the ice to cover the cancer while protecting the urethra and rectum.

Prostate
A walnut-sized gland under the bladder. The ice ball is shaped to cover the cancer or the whole gland.
Urethra
The tube carrying urine through the prostate. A warming catheter keeps it from freezing.
Rectum
The bowel just behind the prostate. The team stops the ice before it reaches the rectal wall.
Urinary sphincter
The muscle below the prostate that holds urine in. A temperature sensor often sits near it.
Perineum
The skin between the scrotum and the anus, where the probes enter.

Why it’s done

Cryoablation is chosen when freezing the cancer offers a good balance of cancer control, side effects and recovery for your situation.

Treating cancer with a short recovery
There is no incision, most men go home the same day or the next, and normal activities resume in 1 to 2 weeks.
Cancer after radiation
When cancer comes back only in the prostate after radiation, freezing is one of the main ways to treat it again.
When surgery is a poor fit
For men whose age or health makes major surgery riskier, cryoablation is a less demanding option.
Focal treatment
Freezing only the cancer area can keep urinary control and erections closer to how they were, with closer follow-up.
Can be repeated
If cancer appears later, cryoablation can often be done again.

Other options

Robotic radical prostatectomy
Removing the whole prostate. More long-term data on cancer control, with a longer recovery and higher chances of leakage.
External beam radiation
Radiation from outside the body over 1 to 9 weeks, sometimes with hormone therapy.
Seed implant (brachytherapy)
Radioactive seeds placed in the prostate in one procedure.
HIFU focal therapy
Destroying the cancer area with focused ultrasound heat from a probe in the rectum.
Active surveillance
Watching a low-risk or some favorable intermediate-risk cancers with PSA tests, MRI and biopsies.
Hormone therapy
Medicines that lower testosterone to control cancer, sometimes used when local treatment is not chosen or after radiation failure.

Getting ready

Tick items off as you go. Your checklist is saved on this device only.

Weeks before

MRI and biopsy

A recent prostate MRI and biopsy map show where the cancer is and whether it is limited enough for focal treatment. After radiation, scans also check that the cancer has not spread.

Prostate size

Very large prostates are harder to freeze evenly. Some men take hormone therapy for a few months first to shrink the gland.

Health check and blood thinners

A pre-procedure visit checks that you are fit for anesthesia. You will be told whether and when to pause any blood thinner. Never stop one on your own.

Talk about sexual function

Ask how your planned treatment zone is likely to affect erections, and whether an erection recovery plan will be offered.

The day before

Bowel preparation

Many teams ask for a clear liquid diet or an enema to empty the rectum, which improves the ultrasound picture.

Fasting

Follow the fasting instructions for anesthesia, usually no solid food after midnight.

Arrange a ride

Someone must drive you home and ideally stay with you the first night.

The morning of

Medicines

Take only the medicines you were told to take, with a sip of water.

Check in

A nurse places an IV, and you receive an antibiotic before the procedure.

In the operating room, step by step

Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.

YouAnesthesia teamLeg supports

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1. Going to sleep and positioning

You are put to sleep or given a spinal anesthetic. You lie on your back with your legs raised in padded supports, and the skin between the scrotum and anus is cleaned. The scrotum is gently lifted out of the way.

You are put to sleep or given a spinal anesthetic. You lie on your back with your legs raised in padded supports, and the skin between the scrotum and anus is cleaned. The scrotum is gently lifted out of the way.
An ultrasound probe in the rectum shows the prostate. A grid template with rows of holes is placed against the perineum to guide each probe to a precise spot.
More detail
Many teams also look into the urethra and bladder with a thin scope at the start or the end, to make sure no probe has crossed into them.
Watching the ultrasound, your urologist places the cryoprobes into planned spots in the prostate. Whole-gland treatment often uses 6 or more probes, and focal treatment uses fewer. Small temperature sensors are placed near the rectum and the sphincter.
More detail
Each probe is only about 1.5 to 2.4 millimeters wide. Some teams inject a little salt water behind the prostate to widen the space between the prostate and the rectum before freezing.
A special catheter that circulates warm fluid is placed in the urethra. It keeps the urethra from freezing, which lowers the chance of tissue sloughing and scarring. Then the freezing begins.
More detail
The warming catheter stays in until the last thaw is complete. Afterward it is swapped for a regular catheter, or a tube through the lower belly.
As gas flows through the probes, an ice ball forms at each tip and grows outward. On ultrasound, its front edge looks like a bright curved line with a dark shadow behind it. The team watches it closely and stops it before it reaches the rectal wall.
More detail
The probe tips get extremely cold, far below minus 100°C. Cells die reliably at about minus 40°C (which is also minus 40°F), so the team aims for the ice to reach that temperature across the whole target, a little beyond the cancer's edge. The sensors give live readings at key points.
The ice is allowed to thaw, either with a thawing gas or on its own, and then a second freeze is done. Two freeze-thaw cycles destroy cells more completely than one. Throughout, the rectal wall stays outside the ice.
More detail
For a large gland, probes may be pulled back partway and the freeze repeated so the ice covers the full length of the prostate from top to bottom.
The probes and the template are removed, and pressure is held on the skin. A catheter, through the penis or the lower belly, drains the bladder while the prostate swells and heals.

After the operation

Right afterward

Waking up
You wake with a catheter and some soreness between the legs. Most men need only mild pain medicine.
Swelling
The scrotum and penis often swell and bruise. Ice packs wrapped in a cloth and snug supportive underwear help.
Medicines
You may go home with pain medicine, an anti-inflammatory, a medicine to relax the prostate, a short course of antibiotics, and a medicine for bladder spasms.
Going home
Most men go home the same day or the next morning after learning catheter care.

At home

Pain and swelling
Soreness between the legs and swelling or bruising of the scrotum and penis peak in the first few days and fade over 1 to 2 weeks. Use ice for 15 to 20 minutes at a time in the first 2 days and wear supportive underwear.
Catheter care
Keep the bag below your bladder, wash the tip of the penis daily, and use a little lubricant where the tube enters. If you have a tube in the lower belly, keep the skin around it clean and dry.
Urine changes
After the catheter is out, burning, frequency and urgency are common for several weeks. Some men pass small bits of tissue as the frozen area heals.
The skin spots
The probe sites heal within a few days. You can shower after 24 to 48 hours.
Fluids and bowels
Drink plenty of fluids and avoid constipation and straining.
Activity
Walk as you like. Avoid heavy lifting, hard exercise and bicycle riding for about 2 weeks.
Sex
Wait until the catheter is out and the swelling has settled, often 2 to 4 weeks. Ask about erection pills or a vacuum device to help recovery.
Driving and work
Most men drive once off strong pain medicine and comfortable sitting, and return to desk work within about a week.

Recovery timeline

Day 0
Treatment day
The procedure takes about 1.5 to 2.5 hours. You go home the same day or the next with a catheter.
Days 1 to 3
Swelling peaks
Scrotal and penile swelling and bruising are often at their worst, then start to fade.
Days 5 to 14
Catheter out
The catheter is removed once the swelling has settled enough for you to pass urine.
Weeks 2 to 8
Healing
Urinary irritation gradually settles. Bits of tissue may pass in the urine.
3 months
First PSA
After whole-gland treatment the PSA should fall to a very low level. After focal treatment it falls but stays above zero.
6 to 12 months
Checking the result
Many programs check with an MRI and sometimes a biopsy, especially after focal treatment.
Long term
Ongoing follow-up
PSA tests continue every few months at first, then less often if stable.

What it feels like

Most men are surprised that the hardest part is the swelling and the urinary irritation, more than pain. Knowing these are expected makes the first weeks less alarming.

Deciding
Choosing between freezing and other treatments can feel uncertain, especially after radiation has already failed.
What helpsAsk about your team's own results for men like you and what follow-up will look like. A second opinion can help you feel settled.
Waking up
Soreness between the legs, the catheter, and sometimes a cold or numb feeling in the area.
What helpsTell the nurse about pain and bladder cramps early. Ice packs help.
The swelling
The scrotum and penis can swell and turn purple or blue within a day or two. Many men are alarmed when they first see it.
What helpsIt is expected and fades over 1 to 2 weeks. Ice, rest with your hips slightly raised, and snug underwear help.
The catheter days
Awkward and uncomfortable, with bladder spasms that can push urine around the tube.
What helpsStrap the tube to your thigh, use lubricant at the tip, and take the spasm medicine if prescribed.
After the catheter is out
Burning, urgency and frequent trips to the bathroom, sometimes with bits of tissue in the urine.
What helpsDrink plenty of water and limit caffeine and alcohol. Call if you cannot pass urine.
Sex and sensation
Erections may be weak or absent, especially after whole-gland treatment. Some men notice numbness of the penis for a while.
What helpsAsk early for an erection recovery plan. Numbness often improves over months.

How well it works

Success means the treated cancer is destroyed, the PSA falls and stays low, and follow-up tests show no significant cancer, with side effects kept as low as possible.

PSA
After whole-gland treatment PSA should fall to a very low level. After focal treatment it falls to a new baseline. A steady rise leads to further tests.
MRI and biopsy
An MRI and sometimes a biopsy about 6 to 12 months later check the treated area.
Retreatment
If cancer remains or returns, cryoablation can often be repeated, or other treatments such as radiation, surgery or hormone therapy can be used.
After radiation
When used after radiation, cryoablation can control cancer in the prostate for many men, but side effects such as leakage and rectal problems are more common.

Risks

Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.

Common

Swelling and bruisingCommon

Swelling and bruising of the scrotum and penis are common and fade over 1 to 2 weeks.

Urinary irritationMost men

Burning, frequency and urgency for several weeks.

Erection problemsMost men after whole-gland treatment

Erection problems are expected after whole-gland treatment, because the ice usually reaches the nerves. They are less common after focal treatment.

Less or no semen

Semen volume often drops, and many men become dry after whole-gland treatment.

Blood in the urine

Usually mild and short-lived.

Less common

Trouble passing urine

Swelling or dead tissue can block urine and may need the catheter longer or put back.

Tissue sloughing

Frozen tissue near the urethra can slough off and block the stream. Sometimes a short scope procedure is needed to clear it.

Penile numbness

Numbness of the penis can happen and usually improves over months.

Urine leakage

Lasting leakage is uncommon after first-time treatment but more common after treatment that follows radiation.

Infection

Urine infection or a swollen, painful testicle (epididymitis) is uncommon and treated with antibiotics.

Narrowing of the urethra

Scar tissue can narrow the urethra and weaken the stream.

Rare

Rectal fistulaFewer than 1 in 100 after first-time treatment

Freezing can rarely create an abnormal channel between the urethra and the rectum, which needs surgery. It is more likely after radiation.

Long-lasting pelvic or rectal pain

Persistent pain in the pelvis, perineum or rectum is rare.

Call your care team or go to the emergency room if

Fever of 101°F (38.3°C) or higher, or shaking chills.
No urine draining from the catheter for 1 to 2 hours with lower belly pain, or after the catheter is out, you cannot pass urine.
Heavy bleeding or clots in the urine.
Gas, stool or bubbles coming out in the urine, or urine coming from the rectum.
Swelling of the scrotum that keeps getting larger, very tense, or very painful.
Severe or worsening pain in the rectum or between the legs.
Swelling or pain in one calf, or sudden shortness of breath (call 911).

Questions to ask your surgeon

Will you freeze the whole prostate or only part of it, and why?
How many cryoablations has your team done, and what are your results?
What are my chances of erection problems and leakage with this plan?
How long will I have the catheter, and will it be through the penis or the belly?
What follow-up tests will I have, and when?
If cancer remains, what are my options?
If I had radiation before, how do my risks change?
Will I need hormone therapy before or after?

Words you may hear

Cryoablation: Destroying tissue by freezing it.
Cryoprobe: A thin needle-like probe that becomes extremely cold at its tip.
Ice ball: The frozen area that forms around each probe tip.
Freeze-thaw cycle: One round of freezing followed by thawing. Two cycles are usually done.
Urethral warming catheter: A catheter that circulates warm fluid to protect the urethra during freezing.
Thermocouple: A tiny temperature sensor placed near the rectum or sphincter during freezing.
Template: A grid with rows of holes placed against the perineum to guide probes.
Salvage treatment: Treatment for cancer that comes back after a first treatment, such as radiation.
Fistula: An abnormal channel between two organs, such as the urethra and the rectum.
Epididymitis: Inflammation or infection of the coiled tube behind the testicle.

Common questions

Does cryoablation hurt?

You are asleep during the procedure. Afterward, most men have soreness and swelling rather than severe pain.

Why does my scrotum swell so much?

Fluid collects in the loose tissue of the scrotum and penis after freezing nearby. It looks dramatic but usually fades in 1 to 2 weeks.

Will I still have erections?

After whole-gland treatment, most men have erection problems and many need treatment for them. After focal treatment, many men keep erections close to before.

Can it be done after radiation?

Yes. Cryoablation is one of the main options when cancer returns only in the prostate after radiation, though side effects are more common in this setting.

Can it be repeated?

Often yes, if cancer remains or returns in the prostate.

Sources this page draws on

American Urological Association and American Society for Radiation Oncology, Clinically Localized Prostate Cancer: AUA/ASTRO Guideline (2022)
American Urological Association, Best Practice Policy Statement on Cryosurgery for the Treatment of Localized Prostate Cancer (2008)
European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer
American Cancer Society, Cryotherapy for Prostate Cancer

Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.