NanoKnife | Modern Focal Therapy in Prostate Cancer

NanoKnife

Modern Focal Therapy in Prostate Cancer 

with full preservation of the instrument and its function

Panagiotis Dimopoulos, Spyros Kampantas, Georgios Karydas

Expanding the limits of focal sublimation therapy for prostate cancer

The NanoKnife system pushes the boundaries of modern focal therapy for localized prostate cancer. Its unique technology, the focal irreversible electroporation (IRE) does not rely on heat to achieve cancer cell death; it uses a more natural method that destroys only the targeted cancer tissue, leaving important prostate structures, including vessels, nerves and tubules, intact.

About the IRE technology of the NanoKnife system

Irreversible electroporation (IRE) is a technique that uses non-thermal energy to create permanent microscopic pores in the cell membrane in order to disrupt cellular homeostasis, which is the ability of a cell to maintain relatively stable conditions inside itself regardless of the conditions of the external environment in which it lives. The disruption of cellular homeostasis prematurely triggers the physiological apoptotic process (Programmed Cell Death) that all cells in the body undergo and leads to permanent cell death. After a sufficient number of high voltage pulses are delivered, the population of cancer cells within the electric field will be irreversibly damaged, resulting in its destruction. Unlike thermal sublimation modalities (HIFU, Laser Ablation, Cryotherapy, etc.), the extent of the anatomical area of IRE electroporation does not need to be adjusted due to its proximity to sensitive structures, such as blood vessels and nerves, and thus brings about more effective treatment of the cancerous tumor, with minimized adverse effects.

Description

NanoKnife needles are placed around the tumour under ultrasound guidance after fusion of the MRI images, just as in Fusion Prostate Biopsies. The needle pairs then deliver a series of high-voltage pulses to the tumor cells. But instead of burning or freezing, like thermal sublimation treatments, NanoKnife's electromagnetic pulses puncture the cell membranes of the cancer cells, which disrupts the cell's balance with the surrounding area, and the body senses that the cell must be destroyed because its membrane has been damaged. The body essentially eliminates the tumour on its own, recognising that there has been damage to all the cancer cells.

The important thing about this technique is that it targets the diseased cells and minimises peripheral damage. We can place the NanoKnife needles next to an artery or vein and destroy the cancerous tissue, leaving the arteries, veins and nerves intact. This gives us a huge advantage.

After treatment, neighbouring, non-cancerous cells migrate and replace the dead cancer cells. There is some evidence that the healthy cells grow and regenerate instead of leaving a hole, allowing the organ to continue to function normally, which only happens with this technique.

NanoKnife surgery for prostate cancer

Nanoknife is particularly useful in the treatment of prostate cancer, as it only attacks the cancer cells within the organ and at the same time helps to maintain its normal function. This means that important structures, such as the vascular bundles responsible for erectile function and the external sphincter of the urethra responsible for male continence, remain intact.

Risks and complications with the NanoKnife procedure

Based on published data, the NanoKnife procedure is very safe and has a very low complication rate. Patients may experience minimal to no side effects.

A possible side effect is that some men may experience infertility due to a decrease in the volume of seminal fluid.

Preparation for the NanoKnife treatment

Before the treatment your surgeon will explain the procedure and answer any questions you may have. You will be asked for either an MRI or PET scan to determine the size, shape and location of your tumour.

He or she will also tell you how long you need to fast before surgery, which medications to stop taking before surgery and when, and any other pre-operative planning information needed.

Finally, the surgeon will explain the possible risks or side effects that may occur, as is often the case with all surgical procedures.

During the NanoKnife

NanoKnife surgery is usually performed under general anesthesia.

Three to five fine needles are inserted into the tumour.

Under ultrasound guidance, short electrical pulses are applied to exactly the right area.

An electric current is then passed through the needles for about two minutes.

The whole process can be completed within 45 minutes.

Postoperative monitoring after NanoKnife

As NanoKnife is minimally invasive, it offers a shorter post-operative recovery period and requires a short hospital stay. Patients are followed up in the hospital and discharged the same or next day. 

After NanoKnife surgery, recovery time is generally short and is limited to a few days. Postoperatively, some patients may need to have a catheter for a few days.

Patient follow-up after NanoKnife

The surgeon will let you know when you can return to your normal routine, including work

Post-operative follow-up appointments will be required as well as post-operative tests including:

• PSA check initially every 3 months.
• MRI scan to confirm that the tumour is shrinking.
• Repeat the biopsy after a few months or years, if there is a reason, depending on the PSA and MRI.

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