How Does NanoKnife Work for Prostate Cancer Treatment?

Originally published: June 2022

Reading Time: 12 minutes
Medically reviewed on: March 20th 2026 Dr Aqua Asif
Authors: Ms Clare Delmar. The Focal Therapy Clinic and Mr Stuart McIntyre, Marketing Director Angiodynamics

At a Glance

NanoKnife IRE (Irreversible Electroporation) is a NICE-approved focal therapy (IPG768) that uses short electrical pulses to destroy cancerous prostate tissue while preserving the nerves, blood vessels, and urethra critical for continence and sexual function. At The Focal Therapy Clinic, our consultants offer NanoKnife alongside HIFU across seven UK locations, with 90%+ of men maintaining sexual function after focal therapy (FTC audit, n=265).

Key takeaways:

• • NICE-approved treatment — NanoKnife IRE is approved under NICE IPG768 for localised prostate cancer
  • Preserves critical structures — destroys cancer cells while sparing nerves, blood vessels, and the urethra
  • Ideal for anterior tumours — particularly suited for cancers in locations difficult to treat with thermal-based therapies
  • Day-case procedure — most patients return home the same day and resume normal activities within 1–2 weeks
  • Strong clinical evidence — supported by international clinical data and the PRESERVE trial

What Is NanoKnife IRE?

NanoKnife IRE (Irreversible Electroporation) is a non-thermal focal therapy approved by NICE under IPG768 for the treatment of localised prostate cancer. Unlike thermal-based treatments such as HIFU, NanoKnife uses short, high-voltage electrical pulses to create tiny pores in cancer cell membranes, causing the cells to die through natural apoptosis — while leaving collagen-rich structures such as blood vessels, nerves, and the urethra intact.

This tissue-selective mechanism makes NanoKnife IRE particularly well-suited for treating tumours located near critical structures, including anterior prostate cancers that can be challenging to reach with other focal therapy approaches.

“NanoKnife offers a genuine non-thermal alternative for men whose tumour location makes thermal ablation less suitable. The ability to preserve the neurovascular bundles and urethra is a significant advantage for maintaining quality of life.”

In the OnFocus podcast below, Stuart McIntyre of AngioDynamics explains how the IRE mechanism was engineered:

Podcast transcript: Stuart McIntyre on how IRE works

Clare Delmar: Hello and welcome to On Focus, brought to you by the Focal Therapy Clinic, where we address issues facing men diagnosed with prostate cancer that are little known, less understood, often avoided and too often ignored. Prostate cancer is the most commonly diagnosed cancer amongst men in the UK. And with this sombre fact comes a multitude of challenges and opportunities. I’m Clare Delmar. Joining me today is Stuart McIntyre, director of marketing and business development at AngioDynamics, where they’re developing a new approach to focal therapy called the NanoKnife.

Stuart McIntyre: We call it irreversible electroporation. That phrase relates to a scientific phenomenon — when you pass a high-voltage alternating electrical field through tissue, those electrons effectively puncture the cell walls of the soft tissue. The cell walls can’t repair themselves and they die a natural apoptotic cell death. Tissues that are rich in collagen and fibrin are not affected in the same way. So it kills the soft tissue cells without disturbing the underlying structure. Vessels and nerve pathways are preserved, whereas the soft tissue cells are killed. That’s the unique feature of irreversible electroporation.

How Does NanoKnife Preserve Healthy Tissue?

NanoKnife IRE selectively destroys cancerous prostate cells while preserving the surrounding structures that are critical for a man’s quality of life — including the urethra, the neurovascular bundles that control erectile function, and the external urinary sphincter. In our clinic’s experience with focal therapy, 97% of patients maintain full urinary continence and 90%+ preserve sexual function (FTC audit, n=265).

This is possible because IRE is a non-thermal technology. Unlike HIFU (which uses heat) or cryotherapy (which uses extreme cold), NanoKnife creates its effect through electrical fields rather than temperature changes. Collagen-rich structures such as blood vessels, nerves, and the urethral wall are resistant to electroporation, so they remain intact while the cancer cells are destroyed.

Outcome	Focal Therapy (FTC data)	Radical Prostatectomy
Sexual function preserved	90%+	30–70%
Urinary continence	97% (FTC audit, n=265)	80–95%
Recovery time	1–2 weeks	4–6 weeks
Hospital stay	Day-case (home same day)	1–3 nights
NICE status	Approved (NanoKnife IPG768 / HIFU IPG424)	Standard care

Source: FTC one-year outcome audit (n=265) and published literature

Podcast transcript: Stuart McIntyre on tissue preservation

Stuart McIntyre: The challenge in the prostate is to destroy the cancerous cells whilst preserving the structures that are critical for the rest of the patient’s health — the urethra, the nerve bundles and nerve pathways that control erectile function. The NanoKnife technology allows those structures to be preserved while still killing the cancerous cells. Each technology offers a particular utility, and NanoKnife joins a group of different interventions, all having merits and to some extent demerits.

Who Is Suitable for NanoKnife Focal Therapy?

Not every man with prostate cancer is suitable for NanoKnife IRE, and at The Focal Therapy Clinic we assess every referral carefully before recommending treatment. NanoKnife is typically most appropriate for men with localised, intermediate-risk prostate cancer — particularly where the tumour is located anteriorly or close to structures that benefit from IRE’s non-thermal, tissue-selective mechanism.

NanoKnife may be suitable if you have:

• Localised prostate cancer — confirmed on mpMRI and targeted biopsy
• Intermediate-risk disease — Gleason 3+4 or 4+3 (Grade Group 2 or 3)
• Anterior or centrally located tumours — where thermal ablation may be less precise
• A desire to preserve quality of life — NanoKnife aims to maintain continence and sexual function

NanoKnife may not be suitable if you have:

• Advanced or metastatic disease — focal therapy treats localised cancer only
• Large-volume, multifocal tumours — where whole-gland treatment may be more appropriate
• A cardiac pacemaker — the electrical pulses may interfere with cardiac devices

“Not every patient is suitable for focal therapy, and we’re transparent about that. We assess every referral carefully with mpMRI and targeted biopsy before recommending treatment.”

For men currently on active surveillance who are considering a move to treatment, NanoKnife offers a way to address the cancer decisively while preserving the option for further treatment in the future if needed. To find out whether NanoKnife is right for you, see our medical suitability page or book a consultation.

Podcast transcript: Stuart McIntyre on personalised treatment

Stuart McIntyre: If one is diagnosed with an intermediate-stage cancer in the prostate, and your options are simply leave it there and hope it doesn’t become life-threatening — that may not be attractive if there is a therapy that can address the cancer decisively whilst retaining those important life features, without removing the possibility of treatment in the future. I envisage NanoKnife will play an increasingly relevant role in creating an early option to address the disease without removing the option of more aggressive treatment later.

Clare Delmar: I often think of focal therapy as the ultimate personalised treatment because it’s so focused — based on targeted imaging, targeted biopsying, and targeted histology — that we know exactly what we’re going for.

What Is the Evidence for NanoKnife IRE?

NanoKnife IRE is approved by NICE under Interventional Procedures Guidance IPG768, confirming sufficient evidence of safety and efficacy for use in treating localised prostate cancer. This approval followed a growing body of clinical evidence from centres in the UK, Germany, France, the United States, and Australia.

The PRESERVE trial — a pivotal, multicentre study evaluating NanoKnife for ablation of prostate tissue in men with intermediate-risk disease — has contributed to this evidence base. At the time of this podcast (2022), the trial had just begun recruiting patients. Since then, NICE has reviewed the cumulative evidence and granted formal approval.

At The Focal Therapy Clinic, our consultants have collectively performed over 2,000 focal therapy procedures across seven UK locations. In our audit of 265 patients, outcomes for focal therapy include:

• 90% cancer-free — at one year follow-up (FTC audit, n=265)
• 97% urinary continence — maintained without pads (FTC audit, n=265)
• 90%+ sexual function — preserved in men with normal function pre-treatment
• 85% return to work — within two weeks of the procedure

For more on focal therapy outcomes, visit our success rates and clinical evidence page or explore the published research.

Podcast transcript: Stuart McIntyre on the PRESERVE trial (2022)

Stuart McIntyre: We’ve just recruited the first patients into the PRESERVE study in the US. It’s important to note that PRESERVE comes on the back of quite a long series of single-centre experience and data, both in the UK, Germany, France, the US, and Australia, where those single centres have reported very interesting outcomes. You don’t go into these more structural studies without first having some good early indication that there is genuine potential in the technology.

Note: This interview was recorded in June 2022. Since then, NICE has approved NanoKnife IRE under IPG768.

What Should You Do Next?

If you have been diagnosed with localised prostate cancer and want to find out whether NanoKnife IRE or another focal therapy may be suitable for you, The Focal Therapy Clinic can help. Our team of consultant urological surgeons will review your MRI scans, biopsy results, and clinical history to recommend the most appropriate treatment pathway.

• Book a consultation — contact our team or call 0207 036 8870
• Learn more about NanoKnife — visit our NanoKnife treatment page
• Compare treatment options — see our treatment options overview
• Understand costs — view our fees page for transparent pricing

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