NanoKnife® prostate cancer treatment
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Prostate cancer is one of the most common oncological diseases in the world. Fortunately, it can usually be cured. Moreover, this is one of the few pathologies that can be treated without surgery. In developed countries, many non-surgical treatments for early stages of cancer have been developed. One of the advanced technologies for tumor destruction is called NanoKnife. It has been used for several years in leading hospitals in Germany and is characterized by higher safety compared to standard methods.
Content
- Principles of NanoKnife treatment for prostate cancer
- Effectiveness of NanoKnife prostate cancer treatment
- Indications for the use of NanoKnife
- How is the procedure performed?
- After the completion of treatment
- Treatment outcomes
- Where can you undergo NanoKnife cancer treatment?
Principles of NanoKnife treatment for prostate cancer
Surgery is considered a standard treatment for localized prostate cancer. It can be performed using open, laparoscopic, or robot-assisted techniques. External beam or contact irradiation of the tumor can also be conducted.
However, in recent years, minimally invasive procedures for prostate cancer have become increasingly popular because they are more sparing. In addition, according to reports from clinical trials, with proper patient selection, minimally invasive treatment provides comparable results with a higher quality of life. When using minimally invasive techniques, men are less likely to suffer from impotence and urinary incontinence.
The NanoKnife procedure for prostate cancer is one of the options for curing the disease forever without surgery. The procedure performed with this device is called irreversible electroporation (IRE).
Electroporation is the formation of nanopores in the cell membrane under the influence of low-energy direct current (LEDC). At low electric field voltages, this process is reversible and does not lead to cell death. At high voltage, electroporation is irreversible, so the affected cells die. Reversible electroporation can be achieved at voltages up to 1 kV, and irreversible electroporation at 3 kV and above.
The mechanism of action of electroporation is to change the cell membrane permeability. As a result, the transport of ions into the cell increases, which leads to its damage.
In medicine, only one device is used to carry out the irreversible electroporation procedure. It is called Nanoknife (NanoBlade), and it is manufactured by the American company AngioDynamics.
NanoKnife therapy has already been tested for many tumors, including liver metastases of colorectal cancer to the liver, pancreatic cancer, and lung tumors. The largest IRENE study was conducted at the German University Hospital Magdeburg, where doctors evaluated the effectiveness of the AngioDynamics NanoKnife™ IRE system for kidney cancer. The greatest success, however, has been achieved in the use of Nanoknife for prostate cancer. In Germany, the NanoKnife procedure is therefore already offered to patients along with conventional treatments for localized prostate cancer, such as surgery, external beam radiation therapy, or brachytherapy.
Effectiveness of NanoKnife prostate cancer treatment
IRE technology was developed in the USA and approved by the FDA in 2006. Already in 2007, prostate cancer was treated for the first time with NanoKnife. Doctors managed to achieve complete tumor destruction. At the same time, not a single case of damage to the urethra, rectum, nerves, or blood vessels in the area of exposure was recorded.
In 2010, the results of the treatment of 34 patients were published. 33 of them had no signs of relapse six months after the procedure. But the main thing is that the method is highly safe. The rate of complications was 15%, but all of them were mild and disappeared without any consequences. Some patients developed temporary urinary incontinence, painful urination, blood in the urine, and urinary tract infections. Not a single case of damage to the nerves and blood vessels located near the tumor was recorded. Potency was completely restored to preoperative levels in all patients.
Further studies have shown that the risk of serious complications when performing irreversible electroporation at stage 1-3 and at the advanced cancer stages is less than 1%.
Thus, cancer treatment using the NanoKnife device is quite effective. Good results have already been obtained in several studies, mainly conducted in Europe, including at the University Hospital London and the Academic Hospital Amsterdam. The main advantage of NanoKnife surgery for prostate cancer is the ability to destroy even hard-to-reach tumors, including those located near nerve fibers, vascular bundles, and pelvic organs.
Indications for the use of NanoKnife
The technique can only be used for early-stage tumors. Initially, NanoKnife was used for newly diagnosed prostate cancer. Today, it is also used for tumor recurrence after radiation therapy.
Below are indications for the use of the NanoKnife 3.0 system to treat prostate cancer:
- Localized prostate cancer
- PSA blood levels up to 15 ng/ml
- Gleason score no more than 7
- No more than one tumor focus in the prostate gland
- T1c-T2a cancer stages
- Patient life expectancy is more than 10 years
Although treatment using NanoKnife technology is offered in many clinics in Europe, the method is not considered standard. It is believed that it should be used if the patient refuses standard treatments for prostate cancer, such as surgery, external beam radiation therapy, and brachytherapy. The patient is also explained the need for careful medical supervision after the procedure so that he can receive timely help in case of a relapse of the disease.
How is the procedure performed?
On the day before surgery, a patient undergoes a diagnostic examination.
Immediately before the procedure, a urinary catheter is placed. It will be used for several days after surgery until bladder function is restored.
Therapy is carried out under general anesthesia. Probes, which look like needles, are inserted into the prostate gland. Precise positioning is ensured by a metal stencil in which the coordinate system is indicated.
The number of probes to be inserted depends on the size and location of the tumor. Typically, two to six probes are required. An electric field is created between them, which destroys prostate tissue.
Once the probes are placed, the NanoBlade begins to work. The device creates many very short pulses, creating nanopores in cell membranes. In this case, there is no thermal effect on the cells, so there are no burns after the procedure. Cells are destroyed not due to heating, as with electrical coagulation, but due to disruption of cellular homeostasis (constancy of the internal environment).
The procedure, which permanently cures prostate cancer in most patients, takes 40 to 60 minutes.
After the completion of treatment
Following the procedure, patients may feel pain in the pelvic and leg muscles because they become tense during the medical procedure. The discomfort goes away after a few days.
A person spends a maximum of one night in the hospital. The day after the procedure, the patient is examined and discharged. Moreover, some clinics carry out NanoKnife treatment in one day without a hospital stay. The patient stays in the hospital for only a few hours and then comes to the clinic for a diagnostic examination the next day.
A urinary catheter is used for 2 to 5 days. After 2 weeks, most of the side effects resulting from the treatment disappear, and the person returns to his normal life, feeling completely healthy.
Irreversible complications are extremely rare. For example, in a review of the literature by M. Valerio, the author notes that the incidence of persistent urinary incontinence after using NanoKnife for prostate cancer treatment was 0%, and the incidence of impotence was also 0%. Further studies found that cases of impotence still occur, but the frequency of this complication is less than 10%. The risk of developing it depends on where the tumor is located. In any case, the likelihood of erectile dysfunction when using NanoKnife is lower than when treating prostate cancer with other methods.
Treatment outcomes
As a result of treating prostate cancer using the NanoKnife procedure, most patients will be cured of this cancer forever. The relapse rate is less than 20%. If a relapse is detected, doctors can provide repeated treatment. In particular, a repeat procedure using the NanoKnife device can be performed.
Although the patient is not given a 100% guarantee of treatment success, no other method can provide it either. When performing surgery or radiation therapy, the risk of cancer recurrence ranges from 10 to 30%, depending on the stage of the cancer.
Where can you undergo NanoKnife cancer treatment?
You can undergo NanoKnife® surgery in Germany at stage one-three and at the advanced cancer stages. The first medical facility in the country to use this procedure for prostate cancer was the University Hospital Heidelberg. They have been treating prostate cancer using NanoKnife technology for several years now. To date, other hospitals have begun to use this device for the minimally invasive destruction of malignant prostate tumors.
You can find a list of hospitals that actively use this procedure on the Booking Health website. The website will also be helpful in getting advice on the treatment of diseases abroad, assistance in selecting the most suitable hospital, and travel organization services. The website contains current prices for all medical procedures, including robotic surgery, cryoablation, external beam or intensity modulated radiation therapy, etc. If you make an appointment for your treatment at a clinic through the Booking Health service, NanoKnife treatment costs will be lower for you due to the absence of additional fees for foreigners.
Choose treatment abroad and you will for sure get the best results!
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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