1. Introduction
NanoKnife IRE prostate cancer treatment is an exciting addition to the array of Focal Therapies now available for the treatment of prostate cancer.
Prostate cancer is the second most common form of cancer in men in the UK with 47,000 cases annually and 11,000 reported deaths annually. Prostate cancer is normally detected in men over the age of 50 with a significantly increased risk for men of African Caribbean descent.
Treating prostate cancer involves a precision diagnostic process and a careful balancing between the need to destroy cancer cells whilst preserving healthy cells with the least impact on a patient’s quality of life.
When detected early, prostate cancer can be treated with a variety of therapies, focal therapy for prostate cancer up to the intermediate grade and confined within the prostate gland and for more advanced cases, robotic prostatectomy/surgery or hormone and radiotherapy treatment
NanoKnife treatment targets and destroys tumours while preserving healthy tissue. This relatively new, Focal Therapy option is growing in popularity as more clinical studies demonstrate its effectiveness in treating and curing hard-to-reach prostate cancer. NanoKnife is used in the treatment of tumours that may otherwise have been deemed unsuitable for HIFU Focal Therapy for prostate cancer.
In this article, we discuss the basics of NanoKnife treatment, including its benefits and risks, what to expect during treatment and its availability in the UK.
II. The importance of understanding all of your treatment options
When faced with a Prostate Cancer diagnosis, it is important to discuss and understand all treatment options available before making an informed decision about which therapy is right for you. Always the critical point is the grade and extent of each patient’s disease and their priorities.
NanoKnife therapy can greatly reduce recovery time and side effects on the prostate’s important functions related to sexual health and urinary control compared to traditional treatments such as radiation and surgery.
III. What is Prostate Cancer NanoKnife?
NanoKnife Therapy is a minimally invasive Focal Therapy option for prostate cancer which is early to intermediate stage and is confined within the prostate gland.
NanoKnife is based on a technology called Irreversible Electroporation (IRE) which uses very short pulses of electricity to create tiny/nano holes in the cell walls of prostate cancer cells. This process is irreversible, meaning that once the cells have been destroyed they cannot regenerate or repair themselves.
Irreversible Electroporation (IRE) employs a series of precisely short electrical pulses which pass through tiny needles, acting like scalpels to target and destroy tumours. The precise placement of the needles is made possible by the use of 3D MRI Imaging Tools enabling surgeons to target the pulses to effectively kill prostate tumour cells in exactly the right area while leaving healthy cells unharmed thus avoiding erectile dysfunction and urinary incontinence.
This permits urologists to achieve a 97% eradication of prostate cancer cells within the targeted area and to minimise impacts on the prostate’s important functions relating to sexual health and urinary continence.
IV. Benefits of NanoKnife Focal Therapy
NanoKnife surgery offers a minimally invasive alternative to more traditional cancer treatments such as surgery or radiation and has benefits relative to more established Focal Therapies in treating hard to reach tumours.
NanoKnife treatment is quick, taking only 40 to 60 minutes to complete, and patients can go home the same day. There is no need for an overnight hospital stay or pain relief, so recovery time is significantly reduced compared to traditional treatments.
In addition, NanoKnife surgery (IRE) offers a high degree of precision in targeting cancerous cells while leaving healthy tissue intact, with 97% of cancerous cells destroyed in the tumour. This helps to preserve sexual function and urinary continence, which are often adversely affected by other treatments.
NanoKnife Therapy using Irreversible Electroporation (IRE) has some advantages compared to Focal Therapy techniques such as HIFU which uses heat or Cryotherapy which uses freezing. These therapies are effective in the main part of the prostate gland and can treat significant tumour volumes but they can be difficult to apply with precision in some critical areas of the prostate gland.
NanoKnife surgery is highly effective at treating smaller hard-to-reach tumours which are very close to critical structures controlling the important functions of the prostate gland. These are the nerves which control erectile function and the sphincter which regulates urinary continence.
Extensive clinical trials have shown that Focal Therapies have an equivalent rate of cancer control at 8 years compared to radical treatments (85%) however they have much lower side effects with minimal impact on erectile function (95% success rate) and almost no issues with urinary continence once the catheter is removed after 4 to 6 days.
NanoKnife technology has not yet had as many Clinical trials as the other Focal Therapies however those that have been completed have provided support for very strong cancer control rates with over 97% in the area treated at 5 years with excellent success in preserving sexual and urinary functions.
A further significant benefit of NanoKnife treatment is that if the initial treatment is unsuccessful it can be repeated.
V. Who is a Candidate for NanoKnife Treatment?
Focal Therapy in general is restricted to patients with clinically significant prostate cancer with a PSA score of 20 or less, a Gleason score of 7 or less and whose prostate cancer is largely confined within the prostate gland.
In cases of extensive disease spreading across and/or beyond the prostate gland and/or high-grade cancer with a Gleason score above 7 the more radical treatment options of surgery, brachytherapy or hormone/radiotherapy treatments are recommended.
Which Focal Therapy treatment option is best for a patient is determined by the location and extent of their prostate cancer based upon a rigorous review of the results of their magnetic resonance imaging (MRI) scans and their precision biopsy and histopathology results.
This review is conducted first by the urologist and then reviewed in a Multidisciplinary Team meeting including oncologists, urologists and radiologists reviewing each patient’s clinical results in detail and agreeing on the possible treatment options in each case. After this, the patient will be informed of the team’s recommendations by the urologist and a final decision will be made in consultation with the patient.
High-Intensity Focused Ultrasound (HIFU) Therapy is the preferred choice for larger volume prostate cancers in the main part of the prostate gland but for smaller prostate cancers occurring in hard-to-reach parts of the prostate gland, NanoKnife (IRE) is a very attractive and preferred treatment option.
VI. How is the NanoKnife Procedure Performed?
The NanoKnife (IRE) surgery is performed as a day-case surgery taking between 40 and 50 minutes. Based upon the result of the MDT meeting the Radiologist will have used the information in the MRI scan along with the histopathology report to provide the urologist with a detailed 3D map of the prostate showing the area to be treated in detail.
The patient is brought to the theatre and put under general anaesthesia to ensure that they experience no discomfort and crucially that they do not move during the procedure. The urologist will guide the thin needles/electrodes into position using the 3D map provided by the Radiologist under Ultrasound Image Guidance. Once satisfied with positioning the urologist will then apply the electric current using the NanoKnife (IRE) technology. Once the procedure is completed the electrodes are removed and the patient is returned to the recovery area.
Patients will be woken after about 20 minutes and can usually leave the hospital within an hour or so of the treatment completion with little or no discomfort albeit with a Catheter in place for between 4 to 6 days.
VII. Accessibility and Cost
NanoKnife (IRE) Therapy for prostate cancer is a relatively new treatment for Prostate Cancer.
In the United Kingdom, it is available only on a restricted basis in the NHS under a clinical trial setting.
In the UK’s private health sector, it is more widely available and its costs are covered by the major insurance providers.
The Focal Therapy Clinic offers NanoKnife (IRE) Therapy in Southampton with Mr Tim Dudderidge, in London with Mr Marc Laniado and Mr Raj Nigam and in Birmingham with Mr Alan Doherty. The Focal Therapy Clinic works with the esteemed uro-radiologist Dr Clare Allen of UCLH for all of its treatment planning.
The Focal Therapy Clinic package price for NanoKnife (IRE) therapy is £15,000.