Focal Therapy for Prostate Cancer – NanoKnife

Not covered by Medicare / Health Fund yet, possibly early 2026

What is IRE

• Irreversible Electroporation Therapy—breaking up of cell membranes using electric current by means of creating holes in the cell walls (Nano-pores)
• Non-thermal ablation

Why is it done?

• Treatment for localized prostate cancer
• Single focus disease
• Prostate preserving
• Ejaculate sparing
• Continence preserving

How is it done?

• Focal therapy of prostate cancer, usually a single lesion
• Preferably Gleason 3,4 or more aggressive
• Preserving prostate supporting tissue and erectile function and continence

You would have had a 3T MRI study possibly a PET PSMA as well prior to confirming your prostate cancer. Usually, whole gland biopsies are taken of the prostate via the perineum to prove unifocal cancer.

• This procedure is done under general anesthesia as a day procedure and takes approximately 60-90min (incl anesthetic time)
• It is performed with the patient lying in lithotomy (legs in stirrups) position
• Prophylactic antibiotics are essential and a script with details is provided on the day of signing consent.
• A trans-rectal ultrasound is placed
• 4-5 NanoKnife electrodes are paced approximately 2cm apart surrounding the focal cancer.
• An electrical current of 3A is run at 800-1331mcs pulse causing a non-thermal ablative technique
• Total treatment as soon as electrodes are placed is < 5 minutes

Complications

Side–effects

• Hematuria (blood in urine) 2-3days
• Hematospermia (blood in ejaculate) will become less the more often you ejaculate.
• Bacteremia (infection) with low-grade fever and feeling unwell
• Perineal hematoma
• Perineal pain and penis tip pain
• Prostate swelling causing bladder outlet obstruction requiring a catheter for up to 5 days

ANY FEVER REQUIRES URGENT ATTENTION

What next?

• You will be discharged with an indwelling catheter for 3-5 days depending on the size of your prostate and the lesion treated
• You may have necrotic tissue developing requiring a resection (treatment involving the urethra).
• Difficulty in urination up to 6 weeks after the procedure
• It could feel like you are sitting on a golf ball for a week

Should there be any signs of fever or cold shivers, you are to return to the hospital or Emergency Department without hesitation

Download Information Sheet

Wes Nanoknife

Copyright 2019 Dr Jo Schoeman