NanoKnife Focal Therapy

What is NanoKnife Focal Therapy?

NanoKnife focal therapy, also referred to as irreversible electroporation (IRE) treatment, is a less invasive surgical procedure used in the treatment of prostate cancer. Focal therapy is a treatment of the section of the prostate containing the significant or main cancer cells while leaving the rest of the prostate intact and unaffected. NanoKnife is a special therapy for prostate cancer that employs electrical pulses to make tiny holes in the cancer cells, causing them to die. It targets only the cancer cells, leaving healthy tissues unharmed. NanoKnife is a minimally invasive option that aims to treat the cancer successfully with minimal side effects than other treatments.

Indications for NanoKnife Focal Therapy

Your physician may recommend NanoKnife focal therapy for hard-to-reach and inoperable prostate cancer cells.

Prostate cancer is one of the most common types of cancer in men. It is defined as the uncontrolled growth of abnormal cells in the prostate gland. The prostate gland is a male reproductive organ that helps in the production of semen. It is situated just under the bladder and in front of the anal passage or rectum. Prostate cancer is typically multifocal, i.e., there are normally several regions of cancer in the gland, but one region will be larger and of a higher grade of malignancy than the rest. The objective of NanoKnife focal therapy is to eliminate the significant or main region of cancer, allowing the other regions to be monitored.

There are several types of focal therapy for prostate cancer, such as high-intensity focused ultrasound (HIFU), focal brachytherapy, photodynamic therapy, and cryotherapy. However, none of these therapies have been specifically effective and can cause damage to surrounding structures such as the sphincter muscle, urethra, and nerves. As a result, we preferably want a therapy that only eliminates the cancer cells, but leaves the surrounding structures undamaged. This is accomplished by the NanoKnife.

Preparation for NanoKnife Focal Therapy

Prior to NanoKnife focal therapy, you will attend a consultation with your physician, who will decide if NanoKnife is the best focal therapy to both treat your prostate cancer and maintain your post-procedure quality of life. In general, your physician will:

  • Review your diagnosis, medical history, and expectations for treatment
  • Order routine diagnostic tests, such as blood work, imaging, and biopsy to check your prostate status
  • Ask about your current medications, supplements, allergies, and any recent illnesses or conditions you have that may be contraindicated for the procedure
  • Ask you to stop taking certain medications such as aspirin or blood thinners
  • Tell you about when you should stop eating/drinking before your procedure
  • Ask you to arrange for someone to drive you home after the procedure
  • Obtain a signed informed consent form after explaining the pros and cons of the treatment

Procedure for NanoKnife Focal Therapy

NanoKnife focal therapy is usually performed under general anaesthetic in a minimally invasive manner without making an incision or surgical cut. During the procedure, under ultrasound guidance, your surgeon will insert 4 to 5 thin needles (electrodes) through the perineum into the prostate to surround the area of significant cancer. Short electrical pulses using very high voltage are then passed between the electrodes. This causes the breakdown of the membrane of the targeted cancer cells, which leads to their death, leaving the surrounding healthy tissues unharmed. A catheter is usually left in the bladder at the end of the procedure for approximately 5 days. This is because the procedure may cause some difficulty in passing urine for some time. The entire procedure should take between 30 and 60 minutes.

Post-Procedure Care and Recovery

In general, post-procedure care and recovery associated with NanoKnife focal therapy include:

  • You will be transferred to the recovery room for observation. You should be able to go home on the same day as your procedure.
  • Postoperatively, you may experience mild to moderate pain and discomfort. You will be discharged home with medications for pain, bladder spasms, relaxation of the prostate, and antibiotics as needed.
  • As the effects of general anaesthesia can take about 24 hours to wear off, you are advised not to drive or operate any machinery during this period.
  • You may experience mild pain and discomfort after the procedure. Medications are provided as needed to address these
  • You should avoid any strenuous activities or heavy lifting for at least a week.
  • You will need to wear the catheter for up to a week. The catheter will be removed during your follow-up and you should be able to pass urine normally and resume sexual activity.
  • Prostate-specific antigen (PSA) test and MRI scan will be ordered routinely after the procedure to monitor the prostate and confirm that the
  • prostate cancer has responded to treatment.
  • A repeat MRI will be performed in 9 to 12 months to ensure that the cancer has been completely eliminated.

Benefits of NanoKnife Focal Therapy

Some of the benefits of NanoKnife focal therapy include:

  • Short hospital stay
  • Short recovery period
  • Minimally invasive with no surgical cuts
  • Painless procedure with minimal to no side effects
  • Able to treat unreachable and inoperable prostate tumours
  • Ultra-precision in targeting cancer cells
  • The procedure can be repeated

Risks and Complications of NanoKnife Focal Therapy

As with any medical procedure, it is possible for risks or complications to occur. These include:

  • Mild to moderate pain
  • Infection
  • Urinary issues
  • Impotence
  • Erectile dysfunction
  • Recurrence of cancer
  • Need for further treatment (only 3% of cases)

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