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The Scottish prostate cryotherapy service–the role of the clinical nurse specialist

10 October 2019
Service Development
02 October 2019
Volume 28 · Issue 18

Abstract

This article outlines the role of the clinical nurse specialist in establishing a Scotland-wide national designated service for prostate cryotherapy for patients with radiation-recurrent prostate cancer. The service was established in 2009 and provides prostate cryotherapy across Scotland. This article reviews and discusses the challenges involved in setting up a new service for tertiary treatment as well as highlighting the key achievements of the service. The challenges have included introducing the cryotherapy procedure in a safe and quality assured manner, developing and refining the referral process, educating both primary and secondary care teams on salvage prostate cryotherapy as a treatment modality and surgical procedure, as well as managing of complications following salvage prostate cryotherapy. The article also outlines the achievements of both the service and the treatment as well as how the service has developed since 2009.

Over 30% of prostate cancer patients are reported to develop recurrent disease following primary radiotherapy (Zietman et al, 2010). For some patients with radiation-recurrent prostate cancer, salvage (second-line) prostate cryotherapy can be a potential curative option. As a result, these minimally invasive treatments have gained popularity as alternatives to androgen deprivation therapy (ADT), which in the past was the only option for the majority of patients with this type of prostate cancer. ADT does not have a curative intent and it can potentially have adverse effects, such as cardiovascular toxicity and metabolic syndrome related to the loss of androgens (Pivonello et al, 2019). For a minority of patients, salvage prostatectomy may be considered, but it is highly challenging and performed only in a handful of centres worldwide (Peters et al, 2013). It also has a very high intrinsic risk of complications resulting from radiation-induced vasculitis, fibrosis and tissue plane obliteration, leading to significant risk of rectal injuries, anastomotic strictures and urinary incontinence (Sivaraman et al, 2018).

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Clinical nurse specialist
Radiation
Cryotherapy
Recurrent prostate cancer