NanoKnife for Prostate Cancer
The knowledge of prostate cancer and its natural history has grown tremendously over the past two decades, and patients with prostate cancer have never had better odds of beating their disease. Prostate cancer is quite unique due to its slow-growing nature in that certain grades or severities of the cancer may not require treatment, which is in contrast to just a few decades ago when all prostate cancer was treated aggressively with either surgery (radical prostatectomy) or radiation (including brachytherapy). Both radical choices have significant risks and side effects. These side effects, such as urinary incontinence and erectile dysfunction, can have a profound impact on the quality of life for both the patient and their spouses.
While prostatectomy and radiation still have a role in prostate cancer therapy, we now have better cancer detection modalities and more knowledge of the natural history and clinical course of prostate cancer. A significant number of prostate cancer patients have low to intermediate risk and do not need radical cancer choices. They may even be candidates for active surveillance.
Enter Nanoknife, also known as focal irreversible electroporation (IRE). This is a minimally invasive way to treat patients with less aggressive disease or who are unsettled by not treating their cancerous lesions in the prostate.
What Is a NanoKnife?
Focal irreversible electroporation, also known as IRE or Nanoknife, is an innovative, minimally invasive treatment option that uses non-thermal energy to create tiny pores in the protective barrier of the cancer cell, which causes cell death. During the procedure, tiny probes are placed around the cancerous lesion, and small bursts of electrical energy are used to create the openings in the cell. Using a non-thermal modality, IRE can be focused over a small area with minimal effects on surrounding tissue such as muscles, nerves, or blood vessels. It is the sparing of the surrounding tissue that may virtually eliminate the side effects of erectile dysfunction and urinary incontinence after this particular prostate cancer treatment. Furthermore, in rare cases, Nanoknife may be repeated if the cancer should return.
How Is NanoKnife Performed?
In a surgery center and under anesthesia, needles tiny needles are placed into the prostate from behind the scrotum. At this point, your urologist deploys the electrical current using precise visual guidance from ultrasound and/or fluoroscopy. This is an outpatient procedure that only requires about 45 to 60 minutes. There is no limit to the number of cancer cells that can be treated, but your urologist will either treat a lesion specifically or direct treatment toward a more significant section of the prostate, depending on biopsy results. After a short recovery at the surgery center, patients will be discharged with a catheter that is removed two to five days later, depending on how much of the prostate was treated.
The risks and considerations of the procedures are relatively mild. Most patients experience discomfort and bladder spasms, which resolve soon after the procedure. Antibiotics may be required on a case-by-case basis.
Follow-up after a NanoKnife is essential, and regular PSAs will be taken to check levels. MRIs of the prostate will be performed shortly after the procedure and then at six months. Your urologist and the Georgia Urology team will develop a plan for a follow-up biopsy, communicate regularly to ensure a successful procedure, and go over results as they are available.