Nanoknife Focal Therapy for Prostate Cancer

Our Approach to Nanoknife

NanoKnife©, also known as IRE (irreversible electroporation), is a form of minimally invasive focal therapy for localized prostate cancer. Short electrical pulses are administered through thin electrodes placed around the tumor to kill cancer cells. The electrical field can be precisely targeted to create tiny holes (or micropores) causing tumor cell death without relying on thermal energy which can destroy surrounding healthy tissue. Nerves, urethra, and sphincter are spared thus improving the likelihood of preserving continence and erectile potency. As a result, NanoKnife© provides the unique benefit of preserving critical structures which are potentially damaged or removed by traditional “whole gland treatments” such as surgery or radiation.

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What We Offer You With Nanoknife Focal Therapy for Prostate Cancer

Multi-disciplinary team of specialist experts

Offering focal therapy for localized prostate cancer, surgery, and radiation treatment. In addition to Prostate Cancer Precision Diagnostic testing , we also offer Transperineal Prostate Biopsy (with MRI fusion) for diagnosis and treatment planning for focal therapy.

Personalized continuum of care

With our dedicated Nanoknife coordinator, Urologic surgeons, MRI Radiologists, Internal Medicine Specialist, and Anesthesiologist team to ensure a comprehensive patient treatment plan.

New, modern facility

Committed for the safest and highest quality care. We also offer concierge programs for out of province and international patients.

What Is Nanoknife?

Benefits of NanoKnife© for prostate cancer:

RELIABLE ABLATION: Electrical pulses to destroy all living cells within the treatment area with no skip lesions
GENEROUS MARGINS: Increased margin expansion without negatively impacting the rates of erectile function and incontinence in men.
LESS COLLATERAL DAMAGE: Ability to ablate across the urethra, nerves, and urinary sphincters to ensure treatment of lesions near vital structures while preserving a patient’s quality of life.
UNMATCHED VERSATILITY: Can treat all segments of the prostate, allowing physicians to build expertise in a single technology to optimize outcomes for patients.
EASY INTEGRATION: Treatment typically takes one hour and seamlessly integrates into your practice utilizing existing imaging and biopsy skills.
CONSERVE FUTURE OPTIONS: Procedures can be repeated if necessary and do not interfere with more standard treatments such as surgery or radiotherapy.
Offers a precise, customizable, and confident treatment alternative for localized prostate cancer.
Real time visualization and imaging guidance
Preservation of critical structures responsible for urinary and sexual function
Minimally invasive short outpatient procedure without surgical wound created or hospital stay required
Offers ability to return to regular activity after a couple of days
The procedure can be repeated and does not preclude other future treatment options if required

The U.S. Food and Drug Administration (FDA) granted 510(k) clearance to the NanoKnife© System for prostate tissue ablation, specifically targeting intermediate-risk prostate cancer. This approval was based on the pivotal PRESERVE clinical study, which demonstrated that 84% of patients were free from clinically significant in-field disease 12 months post-procedure. Notably, the study reported strong quality-of-life outcomes, with urinary continence preserved in 95.4% of patients and a minimal decrease in erectile function.

This FDA clearance positions NanoKnife© as a promising, function-preserving treatment option for men with prostate tumors.

How does Nanoknife treatment work?

The NanoKnife System uses electrical pulses delivered through thin needles to create openings in the walls of targeted prostate cells leading to their death. By preserving the other structures around the cells, it is more likely that urinary and erectile function will return.

Procedure Steps:

Identify the tumor on MRI
Bracket the tumor in probes
Destroy cells with electric pulse

Risks of Nanoknife

A catheter will be required for a few days post procedure.
Some men may experience decreased or absent ejaculatory fluid.
Small amount of blood or seminal fluid in urine from treatment effect.

What to Expect with Nanoknife Focal Therapy for Prostate Cancer

BEFORE

Before the Procedure:

A detailed specialist consultation to assess possible prostate cancer treatment options and eligibility for focal therapy.
Assessment may include multiparametric prostate MRI and fusion transperineal prostate biopsy if indicated.

DURING

During the Procedure:

The procedure is performed under a general anaesthetic and will last approximately 60 minutes. Four to six electrodes are placed through the skin behind the scrotum (the perineum) into the prostate under ultrasound guidance.
A short pulse electrical current is then passed sequentially between each of the electrodes enabling the area of prostate mapped out to be destroyed.

AFTER

After the Procedure:

After treatment the patient will be observed in the day surgery unit before discharged home with a catheter in place.
Postoperatively pain is minimal and patients are discharged with antibiotics, and medications for pain control and bladder spasms as required.
A catheter is left for two to five days depending on the extent of the treatment.
Long term follow-up monitoring post Nanoknife will include PSA testing, repeat MRI prostate, and prostate biopsy.

Frequently Asked Questions and Answers

What is prostate cancer?

The prostate is a small walnut-shaped gland found in men that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is unique in that many prostate tumors do not spread quickly to other parts of the body. Even in cases where prostate cancer spreads, it can often be managed for a long time, allowing those even with advanced prostate cancer, to live with good health and quality of life for many years. An important part of managing prostate cancer is monitoring it for growth over time. Based on the pattern of growth, your doctor can decide the best available treatment options and when to give them.

How is prostate cancer graded?

Prostate cancer is given a grade called a Gleason score, which is the most common prostate cancer grading system used. The score is calculated based on how close the cancer tissue looks like healthy tissue when viewed under a microscope. Cancerous tumors that are less aggressive look more like healthy tissue. Whereas cancerous tumors that are more aggressive are likely to look very different from healthy tissue.

A pathologist, someone who looks at the cancerous cells under a microscope and does comparisons, will observe the cancer cells in the prostate and assign a score on a scale of 3 to 5. They do this for two sections of the prostate that have cancer growth. The cancer cells that look similar to healthy cells are given a low score. The cancer cells that look less like healthy cells are given a higher score. The two scores are added together to come up with the overall Gleason score, which falls between 6 and 10.

What is focal therapy?

Focal therapy specifically targets prostate tumors as opposed to treating the entire gland.

How do I determine if the NanoKnife System is right for me?

Consult a specialist who has experience with the NanoKnife System. Ideal candidates have tumors visible in imaging that determine suitability for treatment.

Where is the NanoKnife System procedure performed?

Treatment can be performed at an ambulatory service center or a hospital. Consult with your doctor to decide which option is best for you.

How long is the procedure?

The treatment is typically an hour. Procedure time may vary based on your unique circumstances.

What are the current treatment options?

Currently, there are six main types of treatment options available for those with prostate cancer. They include:

Active Surveillance

When prostate cancer is not in the advanced stages or immediate treatment options are not yet necessary, active surveillance is suggested. This involves monitoring the cancer for signs that it is worsening. If the cancer is found to be worsening, then a more active treatment will begin, such as those listed below.

Surgery

Prostate cancer surgery involves the removal of the prostate gland and some of the surrounding lymph nodes. The type of surgery depends on the stage of the disease, the man’s overall health, and other factors.

Radiation therapy

Radiation therapy for prostate cancer is used to destroy the cancer cells with the use of high-energy rays. A radiation therapy regimen, or schedule, consists of a specific number of treatments given over a set period of time.

Focal Therapy

Focal therapies are considered less-invasive treatments. They can destroy small prostate tumors without treating the rest of the prostate. These treatments can use different forms of energy to destroy the cancer including heat, cold, or irreversible electroporation. This form of treatment is mostly for intermediate-risk prostate cancer patients.

Systemic Treatments

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Testosterone Suppression Therapy

This form of treatment is based on lowering testosterone levels in the patient. Because prostate cancer growth is driven by male sex hormones called androgens, lowering levels of these hormones can help slow the growth of the cancer. The most common androgen is testosterone. Testosterone levels in the body can be lowered in a number of ways including surgical removal of the testicles or by taking drugs that turn off the function of the testicles.

How long does the catheter stay in?

Typically, 4 days. Catheter duration may be longer based on patient circumstances.

How long will the side effects last?

Side effects will typically last about 1-2 weeks. Actual side effects may be longer based on patient circumstances.

REFERENCES：

Cancer Facts & Statistics. American Cancer Society. https://cancerstatisticscenter.cancer.org/#!/cancer-site/Prostate. Published 2022. Accessed February 7, 2022
Cancer Facts & Figures 2021. American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and figures/2021/cancer-facts-and-figures-2021.pdf. Accessed July 2021.
Prostate Cancer. American Society of Clinical Oncology. Accessed November 2020 from https://www.cancer.net/cancer-types/prostate-cancer
Data on file – Pivotal Study of the NanoKnife System for the Ablation of Prostate Tissue (PRESERVE)

Our Centre

We offer a central location north of Toronto, conveniently located near Hwy 7 and Hwy 404 in Richmond Hill, Ontario.

Treatments and consultations are performed on an outpatient basis in a new private, modern clinic setting with easy-to-access free underground/ surface parking with direct access by VIVA public transit or car. We are adjacent to hotel facilities (Sheraton Parkway Toronto, Courtyard and Residence Inn by Marriott, and Hilton Garden Inn) for our out-of-town patients and their families.

Our center is also fully accessible to individuals with disabilities.

Nanoknife Focal Therapy for Prostate Cancer