Nanoknife

The link is to a story on a new treatment that shows promise for PCa patients. I personally had not heard of this before but the article was posted on another PCa forum. Any thoughts or anyone who has considered or used as therapy?

http://www.baptist-health.com/technology/nanoknife.asp

Don

I checked out the video and now have another experiment to try. They show the insertion of three wires placed adjacent to the outside of the tumor. I assume one is ground and the other two are hot or vice versa. They then send 100 us pulses of high voltage/current to break down cell walls. This does make sense. I know when weeds touch my electric fence it takes a few hits and in a couple of days the weed is dead. The conductive parts of the cell walls are destroyed.

Here's my take. Understand that I have no data, I have not seen this unit, and I have seen no studies so this is just an opinion. However, I am a physicist/engineer and have a good understanding of electrical and acoustic energy flow in all kinds of materials. The electrical field between the electrodes would not be completely enclosed within them. There would not be a hard edge between destroyed and untouched tissue. Think of the iron filing experiment you did as a kid with a magnet. This relies upon exact placement and would work best if the mass is well defined and easily isolated from the healthy tissue. The very same conditions best for surgical techniques. I do not see how this method can spare nerves that are adjacent to the mass.
Maybe someone who has used this machine can correct me.
If I were designing it I'd add a 4th probe with a 4 mm optical fiber so I could send images back to a camera without fear of electrical conduction - similar to Gradient Lens Corp. Hawkeye units.
Jeff

Canegator,

Thanks for the reply. I researched treatments for months before deciding on the radiation. I never came across this procedure in my research. It appears to be very similar to Cryo other than the method of destroying the cells. Do you know if it has been tried or can be used as salvage therapy? I have seen where cryo is sometimes used as salvage for failed radiation. I am more curious than anything else and hoped that this post might give a recently diagnosed patient an alternative to surgery or radiation. In my case I have "crossed the Rubicon" so to speak.

Thanks for the detailed reply.

Don

For Don & Jeff-  I think even if you started radiation you can still have this procedure.  Difference beween cryo and NanoKnife is cryo, although aimed at cancerous area has a "spillover" effect of freezing on adjacent healthy tissue.  Cryo was my choice until I discovered Nano.  In my case, one lesion was very close to nerve, and local cryo doc could not assure me of no nerve damage.  NanoKnife (also known as irreversible electroporation or IRE)) targets specific individual cells without damaging adjacent healthy tissues or nerve bundles.  First question I asked Dr. Narayanan when I "woke up" was about nerve damage and he said there wasn't any.  He was correct on that.

Re: the 2.5 PSA, that is on the low end of "normal" and docs were waiting on that to determine next test.  I assume in 6 months. Just had results today and forwarded to U Miami.  I live about 6 hours north of Miami, so blood work was done here.

I know all of this may seem too good to be true, and I'm having a little trouble believing it myself given my first alternatives, but I hope anyone "tuned in" looks into nanoKnife further and has a urologist or radiologist with an open mind who will look beyond their own fiduciary interest in offering guidance.

I'm serious about the "after effects."  No pain, no bleeding, no problems urinating.  There is still some blood in semen, but had that after the saturation biopsy also.

I'm not sure if I should post specific e-mail addresses, but suggest anyone with further interest do a search for U Miami Sylvester Comprehensive Cancer Clinic and NanoKnife within their site.  Or just do a Google alert for anything on NanoKnife.

I have been researching this in the middle of the night and found the device spec sheet here:
http://www.angiodynamics.com/uploads/pdf/10-08-09-09-51-31-NanoKnife%20Fact%20Sheet.pdf

It shows the pulse definition, (100-3000V, 50 Amp max, very easy for me to do) and it shows the typical ablation pattern. Sure enough, with 1.5 cm spacing between the probes you get about 0.5 cm ablation on the outside! of the probes. The surgeon must take this into account. The 0.5cm will change with material conductivity, probe spacing, and probe voltage.
The laws of physics are hard to break.

I can come up with a shield that could direct the energy and produce a fixed ablation distance but installation would not be a noninvasive procedure.

I do like the concept. I just wish there was a clean way to control the edge.

Jeff

The artist conception drawing in the first link shows the three probes on the outside of the tumor. It does not indicate that the blood vessel nearby is well within the 5mm ablation range and would be damaged, too.

Post Edited (Worried Guy) : 7/15/2010 5:24:11 AM (GMT-6)

If you recall, I was the one who built the super sucker using a lab grade automotive vaccum pump before I got the Augusta VED.

I use Zweigle's hot dogs for my experiments because I can eat them after they pop open. Let's see, I've tried acoustics, RF, thermal and soon high voltage. So far, nothing dices up a dog better than my exacto knife. I think I'll invite our Japanese sushi chef friend over during the GFMPH weekend.
When you have sharp ginsu knives, everything looks like fatty tuna.

Jeff

The post operative pathology following my surgery found spots of cancer here and there in both lobes of the prostate. I've read that PCa often exists as thready patterns throughout the organ, not generally well defined tumors that are seen in some other types of cancer. I don't understand how this nano knife technique would find and destroy those cancerous threads. I can understand how it could be directed at a well defined tumor mass, but what of those cancer cells that are not in that type of tumor? I think I would be forever nervous about cancer cells left behind.

 

Does anyone have an update on NanoKnife treatment for Prostate Cancer?

Is it working?

Were you treated focally or whole gland?

Side effects?

Thanks,

Doug

Thanks JNK.

Any info on their success rate and/or side effects for Nanoknife?

Thanks,

Doug

Recently met with Dr. Narayanan from UM Sylvester Cancer Center regarding the Nano-Knife procedure. He was very helpful, taking the time to answer my many questions, and was very nice as well, even laughing at my lame jokes.

Dr. Narayanan has performed over 150 Nano-Knife procedures for various tumors/cancers, but mine will be just his second prostate cancer procedure, I guess Walter’s was his first. It certainly seems to me that he is well qualified having performed so many procedures. While the prostate may be in a location which is more difficult to reach, it seems that the fundamentals of the procedure would be the same.

I am very pleased that he is having Dr. Jaime Wong from Atlanta fly in as well as the Angiodynamics (Nano-Knife manufacture) team. Dr. Wong is a urology expert who has performed more than 20 prostate Nano-Knife procedures. this team I believe I will have an excellent chance of having the cancer eradicated with no collateral damage.
I am hopeful that my experiences will help others and intend to update my progress regularly. Procedure choice, if any, is a personal one and not every procedure is right for every person. The nano-knife procedure makes a lot of sense to me. This is not medical advice, only my experience, but here is what I learned - the available options for treatment of prostate cancer are basically (1) watchful waiting; (2) Nutritional/diet changes (which Johns Hopkins has been pushing and in my experience does have a real and positive effect); (3) radiation; (4) surgery; (5) hormone therapy; (6) Immunology and gene therapy treatments.

Hormone therapy is generally employed only after other treatments have failed because it only works for a several years at this time before the cancer returns.

Immunology is new and most treatments and drugs are in early clinical trials, meaning that only the most advanced cancer patients qualify. Provenge has been shown to extend life about four months.
http://articles.cnn.com/2010-04-27/health/provenge.prostate.cancer.fda_1_provenge-prostate-cancer-attack-cancer-cells?_s=PM:HEALTH
I do believe that in the near future prostate cancer will be eliminated as some other cancers are being eliminated. Penn has had remarkable success http://www.uphs.upenn.edu/news/News_Releases/2011/08/t-cells/
and I believe there is a clinical study in Boston underway.

So when watching waiting and nutritional therapies are no longer an option, radiation and surgery are the options left. As any type of radiation procedure apparently leaves scarring which can make it more difficult for a surgeon to remove the prostate (and the cancer), surgery seems like the better option. If the cancer is of a smaller volume, targeted procedures may be an option. If not, the entire prostate will likely need to be removed. If targeted procedures are an option, there is cyrotherapy, Hifu, and nano-knife that I am aware of. Hifu is not FDA approved yet and Sonablate, the machines manufacturer, is looking at 2013 now, maybe later. Hifu does work for some and is used in Europe and Asia with good success. Doctors from the U.S. perform the procedure in Canada, Mexico and the Islands. Since it is not FDA approved, insurance does not cover it in a number of circumstances. Cyrotherapy seems to be a good localized treatment option and is approved in the United States.
http://my.clevelandclinic.org/staff_directory/staff_display.aspx?doctorid=3786
(See Doctors Video)

Nano-knife is newer and there is not much data on it. However, it uses electrical current rather than freezing or focused ultrasound to ablate the tissue and seems like it would be as or more precise, and thus, in the hands of skilled Physicians, more likely to reduce the chances of collateral damage to nerves or the urinary tract. There is little or no scarring so surgery is still an option if need be down the road. The procedure can be repeated. You can get out the hospital the same or next day, minimally invasive and quicker recovery time as with most of the targeted procedures. I also like the idea of targeted therapies because as I understand it, the prostate can grow back, at least some, which means that it may still have some of its function.

Nano-knife has been criticized because the machine obtained FDA approval through a ‘loophole’ which allows fast track approval of similar machines already on the market. Given the reported success of Nano-Knife IRE with many different types of cancers, this ‘loophole’ appears to accomplished its goal of getting useful technology to the marketplace more quickly.

HELPFUL LINKS:
http://radiology.med.miami.edu/nanoknife/
http://sylvester.org/documents/Nanoknife_Factsheet.pdf
http://uhealthsystem.com/doctors/profile/1545
http://www.jenkinsclinic.org/about/staff-professionals/wong/
http://www.healthgrades.com/physician/dr-jaime-wong-2sqpg
http://www.baptist-health.com/health_resources/video/detail.aspx?id=138
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=23710
http://www.angiodynamics.com/products/nanoknife
http://files.shareholder.com/downloads/ABEA-3PILLM/0x0x326396/659c162f-80c1-41ff-bda0-942cc8273028/IRE_symposium_presentations.pdf
http://theprostatedecision.wordpress.com/2010/07/31/nano-nano-mork-and-mindy-prostate-cancer-and-new-treatments-insider-tip-when-it-comes-to-new-procedures-in-general-you-dont-want-to-be-the-first-one/

Mark,

Very good update on the subject. If you do this procedure please post results. I am still looking for some further treatment myself as the HT success appears to be fading. My central question is still one of how do you locate the cancer in the body? I have read a bit about the feraheme but I live on the other side of the country from where it is used. Planning on relocating to coastal Georgia in the summer subject to housing market here.

Also thanks for all of the links. Looks like I have an afternoon of surfing ahead.

Don