Prostate Cancer Focal Therapy (with NanoKnife Technique)

PROSTATE CANCER FOCAL TREATMENT – NANOKNIFE TECHNIQUE

One Of Our Patients’ MRI Data Before And After The Nanoknife Procedure:

Before:

After:    

The area of the tumor focus and its surroundings have been completely destroyed (Arrows). Other parts of the prostate gland that do not contain cancer are preserved.

Nanoknife

A new type of treatment method for prostate cancer, IRE (Irreversible Electroporation) is opening up new options for prostate cancer therapy—with a minimum of side effects.

NanoKnife is the first surgical ablation system based on Irreversible Electroporation technology. Nowadays, IRE devices have also entered clinical practice under other brand names such as Dophi (Surgnova).

In NanoKnife treatment, strong electric fields cause cells to die without exposing the tissue to radiation or heating it. This so-called Irreversible Electroporation (IRE) destroys tumor and parenchyma cells. But important anatomical structures in and around the prostate such as nerves, the intestinal wall, the sphincter, veins and arteries are spared. Erection and bladder control are thus spared.

How Does It Work?

The NanoKnife System uses Irreversible Electroporation or IRE. This is a technology in which electrical pulses are applied to a targeted area of cells. The pulses create small holes in the cells’ membranes.

After enough pulses are delivered, the cells initiate a process that mimics apoptosis or natural cell death. The body responds to the apoptotic-like cell death by initiating the removal of cellular debris.

Localizing the area you want to treat is a science of itself, normally done by diagnostic and/or interventional radiologists with many years of experience. Once an agreement has been reached between the specialist physicians, electrodes are inserted into the cancerous area.

Advantages Of Nanoknife

NanoKnife is based on ultrashort (100 µsec) pulses of extremely strong electrical fields. Compared to all standard procedures, this new technology has unique characteristics:

• Tissue selectivity: Only cells, which have a cell membrane—such as cancer cells—are reliably destroyed, while all other structures (nerves, arteries, connective tissue structures, etc.) remain unharmed.
  
  
• Ultrasharp edges: With NanoKnife, the line between “completely removed” and “undamaged” is measured in micrometers. This contrasts favorably with other treatments, such as radiation, heat-based therapies and even surgery, where the central treatment field is always surrounded by an area of unintended tissue damage—often many centimeters in diameter.
  
  
• Induced cell death: NanoKnife induces cell death, or apoptosis, but not radiation damage or burning and consequently no scarring. With current standard procedures such as radiation (protontherapy, brachytherapy, etc.) or heat therapies (HIFU, etc.), a large “toxic” area occurs because the burned tissue is a toxin for the body. The result is inflammation and pain, followed by scarring, all of which prevent or hamper any subsequent treatment that may become necessary in case of a recurrence.
  
  
• No limit on repeated treatment: Because IRE therapy does not cause lasting tissue damage, treatment using all other techniques (radiation, heat, surgery) is still possible without limitation after NanoKnife treatment. NanoKnife treatment can also be repeated as often as necessary.
  
  
• Painless and minimally-invasive: For the reasons mentioned above and because thin needles are the only invasive instrument used, patients usually do not even feel the therapy at all.
  
  
• Quick and in one session: In one single session under general anesthesia, even extensive areas can be treated.

IRE as a technique has been certified by the FDA in the USA and CE in Europe since 2006. It received certification because it was possible in all studies to demonstrate the reliable killing of all cells in a defined area in soft tissue. Nevertheless, two factors are critical for the success of any IRE therapy:

The first is the absolutely correct and precise knowledge of the location of the tumor before treatment.

The second is placement of the electric field in the right position.

What To Expect During The Procedure

1-The procedure is performed percutaneously (the electrodes are placed through the skin and the body does not have to be surgically opened ). Before the procedure begins, you will be sedated and remain sedated until the procedure is complete .

2- During the procedure, your physician will place the electrodes to bracket the targeted tissue. The number of electrodes used can range from 2 to 6, which is determined by your physician before treatment.

3- Once the electrodes are placed, your physician will initiate a series of electrical pulses. The voltage used and time of the procedure are determined by your physician before treatment.

4- After your physician has delivered a sufficient number of pulses to the targeted area, the procedure is complete, and the electrodes are removed.

Side Effects of IRE Treatment for Prostate Cancer

“COMPLICATION RATES STRONGLY DEPEND ON THE LOCATION AND SIZE OF THE PATIENT’S LESION, AS WELL AS THE OPERATOR’S EXPERIENCE.”

Early Side Effects (Immediately After Treatment and First Weeks):

• Tiredness and Lethargy: Patients may feel tired from the anesthesia right after treatment and may continue feeling fatigued for 1-2 weeks as the body heals. This is normal.
  
  

• Urinary Symptoms:
  • Urgency, frequency, getting up at night to urinate
  • Discomfort or burning when passing urine
  • Slower urine flow due to prostate swelling and inflammation
    
    
• These urinary symptoms typically improve over 6 to 8 weeks but can take up to 3 months in some patients.
  
  
• Most patients can return to desk-based work after 2-3 weeks and should avoid strenuous activities or abdominal pressure for the first 4 weeks, gradually resuming over the next 2-3 weeks.
  
  
• Blood in Urine: Occasional blood, blood clots, or tissue debris in urine is common as the body expels dead prostate tissue, similar to how a scab forms on a skin wound.
  
  
• Infections:
  • Urinary tract infections requiring antibiotics can occur.
  • Rarely, infections in the testicle (epididymo-orchitis) may develop.
  • Very rarely, infections may require hospital admission for intravenous antibiotics.
    
    

Rare Complications Related to Surgery or Anesthesia:

• Chest infections
• Blood clots in legs (deep vein thrombosis) or lungs (pulmonary embolism)
• Preventive measures such as compression stockings and blood-thinning injections during surgery are standard.
  
  

Long-Term Side Effects:

• Urinary Incontinence:
  • Risk of needing to wear at least one pad daily is very rare (about 0,2-0,5 %).
  • Risk may be higher if the tumor is near the urinary sphincter muscle; your doctor will advise if this applies.
  •  
• Erectile Dysfunction (ED):
  • Risk varies from 5% to 15% depending on how much prostate tissue is treated and baseline erectile function.
  • Patients with good baseline function have a 5-10 % risk; those with poorer function have a 10-15 % risk.
  • Treating both sides of the prostate roughly doubles the risk.
    
    
• Dry Orgasm (No Seminal Fluid):
  • Average risk is about 15-20 %.
  • High risk if both sides are treated or the treatment is close to the middle prostate where seminal fluid tubes join.
  • Even when fluid is present, volume is usually reduced.
  • If fluid is present, it may contain viable sperm—contraception should be used if pregnancy is not desired.
  • No current effective treatment for dry orgasm.
    
    
• Bowel or Rectal Problems:
  • Long-term bowel problems are very rare.
  • Some patients may experience constipation or bowel upset shortly after treatment, usually resolving quickly.
  • Very rare (1 in 1000 – 0,1 %) risk of recto-urethral fistula (a hole connecting the rectum and urinary tract).
  • If a fistula occurs, long-term catheter drainage is required for healing; surgery may be necessary if healing does not occur.
    
    
• Urethral Narrowing (Stricture):
  • Occurs in about 0,1-1 % of patients.
  • May require surgical removal of necrotic tissue or scar tissue through a cystoscopic procedure under general anesthesia.
    
    

After Procedure

The needle insertion sites close instantaneously after the needles are withdrawn. The patient has no pain. Some people find the catheter unpleasant. The catheter can be removed after one to seven days. Small amounts of blood in the urine or seminal fluid are possible up to several weeks after the procedure because the body may need up to six months to evacuate the tissue destroyed by the NanoKnife procedure’s ablation.

How is follow-up after the treatment?

PSA levels should be checked every 3 months.

In order to check if your prostate cancer is cured or not, you will have prostate MR in specific periods after treatment.

In case of any clinical necessity prostate biopsy might be used to confirm.

If cancer cells are existent, a second NanoKnife  treatment or other focal therapy procedures can be used.