Anybody have IRE - Nano Knife?

Hi gholt,

Welcome to this site. I'm sorry to hear about George's diagnosis, but Memorial Sloan Kettering is one of the best. I applaud his doctor for offering you two very good alternatives to radical (whole gland) therapy.

I didn't have NanoKnife (focal electroporation), and I will be very much surprised if anyone here has. It's quite new and is in clinical trials. I thought it was only in clinical trials in Europe, but apparently MSK is trying it as well. If your doctor has treated anyone else with it, he may be able to give you permission to talk to that person.

Coincidentally, I'll be on an internet radio panel next week to discuss focal therapies. The interview is with Mark Emberton of University College Hospital in London. He is the lead investigator of the clinical trial there of Nanoknife focal therapy, and I plan to ask him about it. He is a leader in the field of focal therapy, and has had great results with focal HIFU. You might want to listen in and call in if you have any questions for him. Here's the link:

Focal Therapy and HIFU for Prostate Cancer with Dr. Mark Emberton on The Cure Panel Talk Show

I'm a little surprised that focal therapy is an option with 3 positive cores and in both lobes, as I've usually only seen it for 2 or fewer cores on one side. (btw - I think his stage with MRI-detected involvement on both lobes would be T2C). You didn't mention the percent of those 3 cores that were cancerous, but I assume it was low.

In over 10 years of tracking, active surveillance (AS) has been shown to be a very safe option in well-selected men. Is there any long-term benefit in terms of side effects or survival between AS and focal therapy? Two-thirds of men on AS do not have any kind of interventional therapy out to 10 years. Ideally there would be a clinical trial where half the men were randomly assigned to focal therapy and half to AS, and their side effects and prostate cancer survival would be tracked until they died of that, or more likely, of something else. (My guess is there would be no difference.)

Lacking that kind of study, a lot of the decision between focal therapy and AS centers around the psychological benefits. After all, when we hear the word "cancer" it is a natural reaction to want to do something proactive about it. But, because PC is most often a multifocal disease and there can never be 100% assurance that the focal therapy got it all, the patient is effectively on AS for the rest of his life anyway. Every man has to decide for himself what he can live with.

Another consideration is whether you want to go with a therapy that is so new.

I struggled with this myself when I chose SBRT when only 3-year results had been published. However the 3-yr results looked so good in terms of oncological control, potency preservation and other SEs, that I was very tempted. As I studied it more, I came to believe that this was simply an improvement over IGRT/IMRT that afforded all the benefits of HDR brachy (a proven therapy) without the bother. The 6-year results and my own experience bore out my leap of faith.

To my knowledge, there are no published research data on Nanoknife for PC, other than in dogs. However, it certainly seems like a good idea. Participation in clinical trials like this benefits us all.

Please let us know what you decide.

I spent some time this afternoon reading about Nano Knife. It sounds very interesting and very promising. Please keep us informed.
Like Allen, I chose SBRT even thought there was not years and years of data on it. What they did have looked great, and so far (and I just completed my treatments a month ago), I'm doing great. i would think MSK would be one of the top places to be in a trial.
Best of luck!
Mike

Very interesting stuff -- had to look it up. For those not familiar with Nano Knife it is the use of electrical currents to kill the tumors. Moderator, we need to add IRE ( Irreversible Electroporation ) to the acronym sticky. Maybe this procedure could be used as the followup treatment when failed radiation precludes surgery? I'd be interested in seeing the side effect reports as more patients do IRE and data is accumulated.

Georgia,

With George's insignificant amount of probably indolent PC, you certainly have plenty of time to investigate and decide on treatment options and to decide if Active Surveillance is something you will be comfortable with. You always have the option of treatment later if you decide on AS. Meeting with lots of doctors and investigating alternatives was certainly part of the process for me.

If you are in the NYC area and interested in learning more about SBRT, the RO who has done more of that than anyone is in your backyard. His publications and contact details can be accessed at:
www.cyberknifeprostateradiosurgery.com/about-dr-katz/

Also, see the link in my signature at the bottom.

One reason that his PSA is low is because there is such low cancer volume. Often the PSA gets higher as we age and the prostate enlarges, contributing to the total PSA. % free PSA can be an indicator, but once his PC is detected on biopsy, its usefulness is pretty much done. It has not been validated for use after treatment -- they just monitor the fall in total PSA.

I'd like to read that email, thank you. If you click on my name at right, my email will be shown.

Hi Allen,

We did indeed listen to the talk show today - as a matter of fact, we were the ones who called in with the nano knife question. You're right - very interesting stuff.

Dr. Emberton said he has done the most (26) nano knife procedures - so I'm wondering what we're going to hear on Monday at Sloan Kettering.

I'm still perplexed when reading the boards here on men with George's stats (just on one side - George has both sides affected) who had prostate removed. Everyone has had different experiences.

Georgia

Age at Dx 61 (61 now)
Gleason 6 (3+3)
3 of 12 cores adecarcinomas plus one high PNI
Both sides of prostate

Post Edited (gholt) : 10/31/2013 9:31:17 PM (GMT-6)