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NANOKNIFE (Irreversible Electroporation)

Nanoknife or irreversible electroporation was developed in 2007 by a team of biomedical engineers at Virginia Technikon and the University of California in Berkeley. It was FDA approved in 2008 and has been used around the world to treat liver, lung, kidney and more recently prostate cancer. It is especially useful in tumours which are deemed ‘inoperable’ and in prostate cancer for tumours which can not be reached by other minimally invasive techniques (such as HIFU) or in certain salvage cases (where previous treatment has taken place).

The Nanoknife uses an electric field that be precisely targeted to create tiny holes in tumour cells while not affecting adjacent organs. Ultraprecision allows treatment of particular areas within the prostate that are difficult to reach by other minimally invasive techniques. Better treatment appears to be produced in small tumours.

Delivery of quick bursts of energy through a set of electrodes which are inserted into and around the tumour create pulses that can last 100 microseconds and create an electric field of up to 3000 volts per centimetre. A cell within range of the electric field will form pores in its fatty membrane, allowing ions to rush through. Exposure to higher voltages and longer pulse duration causes the pores in the cell membrane to remain open and a process of induced apoptosis (natural cell death) occurs.

After treatment, adjacent non-cancerous cells migrate in and replace the dead cancer cells. There is some evidence that healthy cells grow back and regenerate instead of leaving a hole in the organ allowing the organ to continue to function and minimising side effects.

Advantages:

  • Minimally invasive procedure requiring a short hospital stay
  • Short recuperation period (usually a couple of days)
  • Painless procedure with minimal to no side effects
  • Able to treat tumours previously difficult to treat with minimally invasive procedures or in salvage cases
  • The procedure can be repeated

Disadvantages:

  • Catheter required for a few days
  • Some men may be infertile due to decreased/absent ejaculatory fluid
  • No long term data available on side-effects and outcomes

Men suitable for Nanoknife treatment are carefully selected following MRI and prostate mapping biopsies under the care of Professor Mark Emberton at LUA. He will discuss the suitability of this type of treatment for the prostate cancer diagnosed. It is not suitable for all types of prostate cancer and men who are given the option will be made aware that no long term data is available. For more information call our office on 020 7224 5089.

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