THE "NEW" PROSTATE CANCER INFOLINK

As yet there are no published data at all (that we are aware of) on the clinical application of irreversible electroporation (NanoKnife^®) technology in the treatment of localized prostate cancer. However, we know there is growing curiosity and so we thought it might be useful to offer readers links to the reasonably reliable source information that is available on the web.

We should be clear up front that NanoKnife technology appears to be a method that has considerable potential in the focal therapy of low-risk, localized prostate cancer (and some other prostate cancer-related uses, as discussed below). This technology has been approved by the U.S. Food & Drug Administration for “the surgical ablation of soft tissue.”  It has not been approved for the treatment of prostate cancer or any other specific disease or condition.

However, many men who might consider this form of treatment should also have a serious discussion with their doctor(s) about the risks and benefits of active monitoring (so-called “active surveillance”) as an appropriate option before considering irreversible electroporation. Why? Because there is a considerable probability that they may have a form of prostate cancer that will never have clinical impact in their lifetimes.

Here is a listing of the useful resources that we were able to find:

• There is a clear and simple (and brief) video on the Memorial Sloan-Kettering Cancer Center web site in which Dr. Jonathan Coleman gives an introductory presentation about how the NanoKnife procedure works. He claims in this video that significant side effects associated with this type of focal treatment for localized prostate cancer are relatively infrequent.

• There is additional information (including more video) on the web site of the Baptist Health system. (Baptist has been using this technology at one of its hospitals in Little Rock, AR.) However, this information is not specific to prostate cancer.

• There is some brief patient discussion about experience with NanoKnife treatment for prostate cancer on the WebMD prostate cancer community web site.

• There is detailed information about the application of NanoKnife techniques in the treatment of prostate cancer on the web site of the Prostate Cancer at the Institut für Bildgebende Dagnostik in Offenbach-Kaiserlei, Germany (along with the price for work-up and treatment at €29,900).

• Interestingly, at the London Urology Center in the UK, Dr. Emberton and colleagues (and at the center in Offenbach-Kaiserlei) appear to consider this technology to have specific value in salvage therapy for men who have received prior treatment. In other words, it may have value after almost any other form of customary first-line treatment to eliminate small foci of localized disease left behind after the initial treatment.

• On the YouTube web site, there is a television news report from a CBS affiliate in Atlanta containing interviews with Dr. Jaime Wong and one of his patients. (Dr. Wong is one of the first physicians in the world to start using this technology for the treatment of prostate cancer.)

• There are two small clinical trials (one in London, UK, and the other in Amsterdam) in start-up phase that are looking at the safety of using this technology in the treatment of prostate cancer.

The bottom line at present is that we have no reliable data at all to help patients make good decisions and so if you want to consider treatment for any form of prostate cancer using irreversible electroporation, there are a number of issues you need to consider, as follows:

• Make absolutely sure that your insurance provider is going to cover the costs associated with this treatment. At least some providers may consider the treatment to be “investigational” or “experimental.”
• Make absolutely sure that the physician you go to see have done this at least a few times already. There is little doubt that the best achievable results from the use of this treatment will be most likely when the treatment is carried out by a well-trained and highly skilled surgeon or interventional radiologist with extensive experience in the use of the technology.
• Do be aware that, as with all forms of surgical intervention, there is risk for side effects. There was an article in The Wall Street Journal addressing risk for side effects associated with the early use of NanoKnife surgery as long ago as 2010. At least some of the treating physicians are being clear with patients that treatment may have side effects associated with erectile and sexual functions.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: electroporation, irreversible, NanoKnife, technology |