NanoKnife Prostate Cancer Treatment

How does Nanoknife Focal Therapy work?

NanoKnife works by using a technology called irreversible electroporation (IRE) to destroy cancerous tissue without significant damage to surrounding critical structures like nerves, blood vessels, and organs. Here’s how it works:

1. Insertion of Electrodes

A surgeon places thin needle-like electrodes around the tumor using imaging guidance (ultrasound, CT, or MRI). These electrodes are positioned precisely to target the cancerous area while sparing healthy tissue.

2. Delivery of Electrical Pulses

High-voltage, low-energy electrical pulses are delivered between the electrodes. These pulses create tiny holes (nanopores) in the cancer cell membranes, disrupting their function and leading to cell death.

3. Cell Death Without Heat

Unlike traditional thermal ablation (which uses heat or cold), NanoKnife does not rely on extreme temperatures.

This non-thermal approach prevents damage to nearby blood vessels, nerves, and delicate structures, making it ideal for treating tumors in sensitive areas like the prostate, liver, and pancreas.

4. Natural Clearance by the Body

Over time, the body naturally removes the dead cancer cells, allowing healthy tissue to regenerate.

Why Choose Nanoknife Focal Therapy for Prostate Cancer?

Nanoknife Focal Therapy for prostate cancer offers several benefits and positive treatment outcomes. By selectively targeting and destroying cancer cells, Nanoknife Focal Therapy minimises damage to surrounding healthy tissue, reducing the risk of side effects such as erectile dysfunction and incontinence.

Studies have shown that Nanoknife Focal Therapy has a low complication rate and produces minimal to no side effects in most patients. The precision of the treatment allows for effective tumor treatment without requiring the entire gland to be treated, preserving important functions of the prostate.

The short duration of the procedure and faster post-operative recovery time contribute to a shorter hospital stay.

Medium-term studies have shown excellent results. Most patients had complete eradication of cancerous tissue within the treatment zone, and the majority maintain continence and erectile function after the treatment.

How is Nanoknife Focal Therapy done?

After a thorough evaluation to confirm patients' eligibility for NanoKnife treatment, they undergo a day surgery procedure under general anaesthesia, lasting around 45 to 60 minutes.

Depending on the size and location of the cancer, the procedure may involve ablating the lesion, a quarter of the prostate, or half of the prostate.

Typically, 4-6 thin needles are inserted around the cancerous tissue and high voltage electric pulses are passed between them. These pulses create pores or defects in the cell membranes, leading to cancer cell death.

Following the procedure, patients remain in the day surgery unit for a few hours before being discharged with an urinary catheter in place. Postoperative symptoms are typically mild, and you will be discharged with medications for pain, bladder spasms, prostate relaxation, and antibiotics if required.

The Foley catheter remains in place for 5-7 days, depending on the extent of the treatment. Within 4 weeks after NanoKnife treatment, a limited multiparametric MRI is performed to ensure the treatment coverage is satisfactory.

How effective is NanoKnife at treating prostate cancer?

NanoKnife is generally very effective at destroying the cancer within the area that is treated. Across multiple studies — including work involving Prof. Stricker (Ting 2016; Blazevski 2020; Scheltema 2023), early NEAT/Valerio biopsy studies, the Guenther 2019 registry, and the Zhang et al. 2023 randomised trial — the in-field recurrence rate is usually low, commonly around 5–10%. This means the success rate is 90-95%.

Most patients remain free of needing further radical treatment for years, with medium-term follow-up from the Stricker group showing 84–91% of men still avoiding whole-gland treatment at 3–5 years.

These results show that NanoKnife is a strong focal therapy option when used in the right patients and by experienced teams.

Can prostate cancer return after NanoKnife treatment?

Yes, it can — either inside the treated area or elsewhere in the prostate.

Inside the treatment zone: recurrence is typically low (about 5–10%) in expert centres, as seen in Prof. Stricker-associated studies (Ting 2016; Blazevski 2020; Scheltema 2023) and other biopsy-verified studies like NEAT/Valerio.

Outside the treated area: new cancer can appear elsewhere in the prostate over time. Studies including Stricker’s cohorts, the Guenther 2019 registry, and the Zhang 2023 randomised trial show out-of-field recurrence can range from ~10% to 20%+, which reflects the naturally multifocal behaviour of prostate cancer.

Overall, cancer recurrence after NanoKnife is possible, but most men avoid needing further whole-gland or salvage treatments for years.

Risks & Possible Side Effects

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

Cancer-Control Risks

• Cancer may persist inside the treated area (in-field recurrence)

• Cancer may appear elsewhere in the prostate (out-of-field recurrence)

• Additional treatment (repeat IRE, radiation, or surgery) may be required

Conclusion

While traditional treatments such as surgery and radiation therapy have been the go-to options, focal therapies like NanoKnife Focal Therapy are gaining recognition. This minimally invasive treatment option effectively targets and destroys cancer cells while minimising damage to surrounding healthy tissue, offering improved patient outcomes and reduced side effects compared to traditional treatments.

If you would like to learn more about Nanoknife Focal Therapy and explore whether this treatment is suitable for you, contact Dr. James Chen to make an appointment.