|‘We are using state of the art imaging techniques (mpMRI, fusion biopsy and PSMA-PET/CT and PSMA-PET/MRI data) for selecting suitable patients for’ focal therapies and for follow-up after procedures’
PROSTATE CANCER FOCAL TREATMENT – NANOKNIFE TECHNIQUE
ONE OF OUR PATIENTS’ MRI DATA BEFORE AND AFTER THE NANOKNIFE PROCEDURE:
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.
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,
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.
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.