HIFU, or high-intensity focused ultrasound, and NanoKnife, also known as reversible irreversible electroporation, are excellent focal therapies in the treatment of prostate cancer. When we say focal, in the context of cancer treatment, we mean that these procedures allow your surgeon to target small areas of the prostate rather than the entire prostate gland. By doing so, focal therapy may reduce the incidence of serious side effects like erectile dysfunction and urinary incontinence. So, with that, let’s compare the two!
Method of Function/Technology
The technology used in each of these therapies is quite different. HIFU uses ultrasound waves to heat prostatic tissue and destroy cancerous prostate cells. On the other hand, NanoKnife uses irreversible electroporation, a recent technology that involves deploying a short burst of electrical current to destroy the tumor without heat. This creates tiny holes in the outer shell of the cancerous cell. Soon, the cell is destroyed, while other surrounding structures are left unharmed. In both cases, the treatment is focused on a target zone within the prostate reducing the side effects compared to traditional robotic prostatectomy (prostate removal) or prostate radiation.
Accessing the Prostate
The technologies access the prostate differently. NanoKnife deploys electrodes placed through the perineum (area of skin between the scrotum and anus). While this access point is more invasive, it allows NanoKnife to target any part of the prostate. On the other hand, the ultrasound probe used for HIFU is inserted into the rectum and treated upward to the prostate. For this reason, HIFU is most often used for posterior lesions, those toward the back of the prostate, and NanoKnife, the anterior and forward aspect of the prostate.
Insurance Coverage
The procedures differ in their insurance coverage. HIFU has been covered under most commercial insurance plans and Medicare since 2023. Conversely, NanoKnife will not be fully covered until January 2026. With that said, we have had some success getting the NanoKnife procedure covered by commercial insurance, but this is not the norm. Patients can also opt for self-pay
The Bottom Line
The two focal therapies we offer, HIFU and NanoKnife are both less invasive with fewer side effects than a radical prostatectomy for unilateral intermediate-grade prostate cancer in appropriately selected patients. Radical prostatectomy and radiation are more appropriate for high-grade prostate cancers.
Georgia Urology offers a wide range of prostate cancer treatments. The Georgia Urology physicians are well-equipped to help you understand which treatment option is best for you.
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