Cryotherapy and Cryosurgery
Cryotherapy seems to be everywhere—from dermatology to sports medicine. What's evidence-based?
A (Dermatologist - Cryosurgery): Cryosurgery is gold standard for actinic keratoses, seborrheic keratoses, and many benign lesions. Liquid nitrogen (-196°C) is cheap, effective, and requires no anesthesia for superficial lesions. For skin cancers (basal cell, squamous cell in situ), cure rates approach 99% for well-defined lesions, but you lose tissue for pathology.
B (Oncologist - Cryoablation): In oncology, percutaneous cryoablation is a minimally invasive treatment for small renal tumors (T1a), liver metastases, and bone tumors. It's less painful than radiofrequency ablation (RFA) because cold has an analgesic effect. The ice ball can be monitored on CT or ultrasound in real-time, giving precise margins.
C (Sports Medicine Physician): Whole-body cryotherapy (WBC) for recovery after exercise is mostly hype. The evidence for reduced inflammation or faster recovery is weak and confounded by placebo. Localized cryotherapy (ice packs, cold water immersion) is effective for acute injury management (first 24-48 hours). WBC chambers are expensive wellness theater.
D (Patient - Prostate Cancer): I had focal cryoablation for my prostate cancer. No incontinence, no erectile dysfunction, back to work in 3 days. Why isn't this offered more? My first urologist only talked about surgery or radiation. Patients need to know that "freezing the tumor" is a real option for select cases.