NanoKnife Prostate Cancer Treatment

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.

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 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:

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.

1. Insertion of Electrodes

Needle-like electrodes (between 4 to 6 electrodes) are inserted around the tumor using ultrasound guidance. 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 minimally-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.

What happens after NanoKnife Focal Therapy?

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.

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.

Subsequently, your PSA will be monitored 3 monthly and a repeat prostate MRI and a repeat prostate biopsy will be arranged in 6-12 months time to check for cancer clearance.

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 around 90-95%.

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 30%, 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.

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