NanoKnife (IRE) for prostate cancer treatment

What is NanoKnife?

NanoKnife, also known as Irreversible Electroporation (IRE) treatment, uses short, powerful electrical pulses through small needles to destroy targeted prostate cancer cells. It is a type of focal therapy for prostate cancer, meaning it treats only the cancerous cells, leaving healthy tissue untouched. Additionally, NanoKnife is a non-thermal (not heat or cold-based) treatment, which helps to protect the delicate nerves and muscles responsible for erections and bladder control.

What are the benefits of NanoKnife?

1. Minimally invasive: As NanoKnife does not involve any cutting, stitching, heat or cold, there is less pain and quicker recovery.
2. Quick recovery: Most people can return to normal activities within 2 weeks.
3. Targeted: NanoKnife targets cancer cells, preserving healthy prostate tissue.
4. Lower risk of side effects: As NanoKnife is non-thermal (not heat-based) it protects nerves and muscles responsible for erections and bladder control.
5. Treats difficult tumours: Treats tumours that are close to vital structures like the urethra or rectal wall.
6. Repeatable: Unlike radiation, the treatment can be repeated if necessary.

Is NanoKnife right for me?

NanoKnife may be a good option if:

• Your cancer is localised (The cancer has not spread outside of the prostate gland).
• Your tumour is in an area where surgery or radiation could damage nearby nerves or organs.
• You want to minimise the risk of side effects such as incontinence or erectile dysfunction.

To determine if you are suitable for NanoKnife, you will undergo several diagnostic tests, such as blood tests to measure the level of prostate-specific antigen (PSA) and take a sample of tissue (biopsy) from the prostate.

What happens during NanoKnife?

How to prepare for NanoKnife

Your urology consultant and the hospital team will give you instructions on how to prepare for NanoKnife, and it is important to follow them carefully. They will review your medical history and current medications, including prescription medications, over-the-counter drugs, and supplements. They will advise you on whether to continue or temporarily stop taking medicines before and after the procedure.

To get a better look at your prostate, you may need to complete a bowel prep or enema.

As NanoKnife is performed under general anaesthesia, you will need to stop eating and drinking several hours before your procedure.

Before you leave the hospital, your urology consultant and healthcare team will give you instructions on how to recover at home.

During the procedure

NanoKnife typically takes between 1 to 2 hours. You will be given a general anaesthetic, so you will be completely asleep and won’t feel any pain.

We’ll place a urinary catheter to help empty your bladder. This is because swelling after the procedure can make it difficult to urinate on your own. The catheter will let the area heal while the swelling goes down.

1. A transrectal ultrasound device is gently inserted into your back passage (rectum). This allows your urological surgeon to see your prostate in real-time and guide the placement of the needles.
2. Your surgeon will insert several thin needles (electrodes) through the skin of the perineum (the area between the scrotum and anus) and into the prostate.
3. The NanoKnife System then delivers electrical pulses between the needles. These pulses create small holes in the cancer cells and cause them to die off naturally. Your body’s immune system will clear away the dead cells over time.
4. Your surgeon will remove the needles.

After the procedure

Once your procedure is complete, you will be taken to the recovery room, where you will be monitored as you wake up. When you are fully awake and stable, you’ll be taken to your hospital room.

You may experience some pain, swelling or bruising in the perineal area. You will be given pain medication to help manage the pain.

You should be able to go home the same day. Please arrange for someone to pick you up from the hospital, as you will not be able to drive and stay with you for at least 24 hours following your procedure.

Recovery after NanoKnife

Before leaving the hospital, your urology consultant and healthcare team will give you instructions on how to recover at home:

• Rest: Get plenty of rest, especially in the first week following your surgery.
• Activity: Avoid strenuous exercise, cycling and heavy lifting for at least two weeks.
• Driving: Do not drive for at least 48 hours after a general anaesthetic.
• Catheter: You will be shown how to empty and care for your catheter. You will need to have the catheter in for 1 to 3 days.
• Sexual intercourse: Avoid sexual intercourse until your catheter has been removed, and you have been given the “all clear” from your urology consultant. This is often 1 to 2 weeks after the procedure.

What are the risks of NanoKnife?

Most people recover well after NanoKnife. However, like any medical procedure, complications can occur. Your urology consultant and healthcare team will discuss all the risks and complications with you in detail.

General complications may include:

• Pain: Post-operative pain is normal and is usually manageable with medication.
• Bleeding and bruising: Some bleeding is expected, but if you experience heavy or continuous bleeding, contact your urology consultant immediately.
• Infection.
• Reaction to anaesthetic: For example, nausea and vomiting.
• Blood clots (Deep vein Thrombosis DVT): A risk associated with any procedure performed under general anaesthesia.

Specific complications may include:

• Blood in your urine: Most people will see blood in their urine. It will settle within a few days or weeks.
• Need to pass urine more often or urgently: Some people may experience the need to go to the toilet more often. In most cases, symptoms will settle within a few days or weeks. If it doesn’t, please get in touch with your urology consultant or healthcare team.
• Swelling: Some men may experience swelling of the penis and scrotum. This is temporary and will resolve within 1 to 2 months.
• Numbness: Some men may develop tingling or numbness around the penis. This is temporary and will resolve in 2 to 4 months.
• Incomplete treatment: There's a small chance that some cancer cells may not be destroyed, which could require further treatment. This will be monitored with follow-up PSA tests, MRI scans and biopsies.
• Urinary tract infection (UTI): If you experience a burning or stinging sensation when passing urine, see blood in the urine, feel pain in the lower belly or pelvis, or need to go to the toilet often, this can be a sign of a urinary infection. Please get in touch with your urology consultant, healthcare team or GP immediately.
• Erectile dysfunction: The nerves that control penile erections are very close to the prostate gland. The risk of erectile dysfunction is low with NanoKnife, but some people may experience trouble getting or keeping an erection afterwards. This is often temporary but can be permanent.
• Urethral Stricture: Although rare, scar tissue can cause a narrowing of the urethra, which may require a further procedure to correct.

Are there alternatives to Nanoknife?

• Active surveillance: For low-risk cancers, involving regular monitoring.
• Radical prostatectomy: Surgical removal of the entire prostate gland, sometimes with the nearby lymphatic glands.
• Brachytherapy: Placing radioactive seeds inside the prostate.
• Radiotherapy: Using high-energy particles or waves, such as X-rays, gamma rays or protons, to destroy or damage cancer cells.
• Lutetium-177 PSMA therapy: Targeted radiation to kill cancer cells.
• High-intensity focused ultrasound (HIFU): A treatment that uses high-frequency sound waves to destroy cancerous cells in the prostate.
• Cryotherapy: Using very cold temperatures to kill cancerous tissue.