Frequently Asked Questions about NanoKnife® Focal Therapy

  • NanoKnife® is most suitable for men with localised prostate cancer where the cancer is confined to one area of the prostate and can be accurately identified on MRI and targeted biopsy. It is generally considered for men with carefully selected low- to intermediate-risk prostate cancer who wish to preserve urinary continence and sexual function while avoiding whole-gland treatment.

    Before recommending NanoKnife®, I perform a comprehensive assessment that may include:

    • Multiparametric MRI (mpMRI)

    • Transperineal MRI-targeted prostate biopsy

    • PSA testing

    • PSMA PET scan

    • Review of your overall health and treatment goals

    Not everyone is suitable for focal therapy. Men with extensive or high-risk prostate cancer involving multiple areas of the prostate would achieve better cancer control with radical prostatectomy or radiotherapy. During your consultation, I will discuss all appropriate treatment options and help determine whether NanoKnife® is the best choice for your individual situation.

  • For appropriately selected men with localised prostate cancer, NanoKnife® can successfully eradicate the treated tumour and provide excellent medium-term cancer control. However, unlike radical prostatectomy, NanoKnife® treats only the known cancer while preserving the remainder of the prostate.

    This means:

    • The treated cancer can often be completely destroyed.

    • Small undetected areas of cancer elsewhere in the prostate may remain or new cancer develop over time.

    • Ongoing surveillance is an essential part of treatment.

    After NanoKnife®, patients continue regular follow-up with PSA testing, MRI scans and, when indicated, repeat prostate biopsy. If cancer recurs or new cancer develops, further focal treatment, surgery or radiotherapy usually remain available.

    The goal of NanoKnife® is to achieve excellent cancer control while minimising the impact on quality of life.

  • One of the major advantages of NanoKnife® is that it is designed to preserve the structures responsible for urinary continence and erectile function by avoiding heat or freezing damage to surrounding tissues.

    Most men recover quickly and experience fewer side effects than with whole-gland surgery or radiotherapy, although every procedure carries risks.

    Potential side effects include:

    Common

    • Temporary urinary frequency, urgency, or burning

    • Blood in urine or semen

    • Perineal discomfort or bruising

    • Temporary erectile weakness

    • Short-term catheter use

    Less Common

    • Urinary retention

    • Infection

    • Perineal hematoma

    Rare but Serious

    • Rectourethral fistula

    • Significant bleeding

    • Injury to urethra, sphincter, or nerves

    • Persistent erectile dysfunction

    Most patients return home the same day or after one night in hospital and resume normal daily activities within several days.

  • Yes. Dr James Chen has been offering NanoKnife® focal therapy for prostate cancer in Perth since March 2025 at Bethesda Hospital.

    If you would like to know whether NanoKnife® is suitable for you, Dr Chen would be happy to discuss your individual case and treatment options.

  • Long-term oncological outcomes (Scheltema et al., BJU International 2023)

    229 men treated with focal IRE (NanoKnife®)

    • Median follow-up: 5 years (range up to 10 years)

    • 86% intermediate-risk disease

    • 7% high-risk disease

    Cancer control

    • Failure-free survival

      • 91% at 3 years

      • 84% at 5 years

      • 69% at 8 years

    • Metastasis-free survival: 99.6%

    • Prostate cancer-specific survival: 100%

    • Overall survival: 100%

    Failure-free survival refers to the proportion of men who remain free from major treatment failure after NanoKnife®. This means they have not required surgery, radiotherapy or hormone therapy, have not developed metastatic prostate cancer, and have not died from prostate cancer. It is one of the most commonly reported measures of long-term cancer control following focal therapy.