Focal Therapy for Prostate Cancer with NanoKnife™
Focal therapy for prostate cancer using the NanoKnife enables targeted destruction of cancer cells while preserving the surrounding healthy tissue. It is an innovative procedure that uses irreversible electroporation (IRE), a technology that employs short, high-voltage electrical pulses to selectively destroy tumor cells, while largely sparing healthy prostate tissue and important anatomical structures. This allows effective and precise treatment of prostate cancer with a significantly lower risk of complications compared to conventional surgical procedures or radiation therapy.
NanoKnife is therefore not a surgical scalpel in the traditional sense, but an advanced medical system that uses electrical energy to destroy cancer cells. Its technology is based on the process of irreversible electroporation (IRE), during which microscopic pores (nanopores) are created in the cell membranes of the tumor. Due to permanent damage, the cell membranes lose their balance with the surrounding environment and the cells die through a natural process of programmed cell death (apoptosis). The body then naturally removes the dead cells via the immune system, replacing them with healthy tissue.
Advantages of focal therapy
Compared to radical treatment methods, the NanoKnife provides a precise, targeted approach that treats only the diseased tissue, thereby preserving healthy cells. In addition, NanoKnife works in a non-thermal manner, preserving collagen fibers and supportive structures, unlike other ablative methods such as laser or radiofrequency ablation, which rely on extreme heat, or extreme cold (e.g. cryotherapy). This means that blood vessels, nerves and urinary structures passing through or near the treated area remain intact, significantly reducing the risk of side effects such as urinary incontinence and erectile dysfunction.
When prostate cancer is diagnosed, treatment is often conservative and may include active surveillance without immediate intervention, or radical methods such as prostatectomy and radiation therapy, in which the entire prostate is removed or irradiated. NanoKnife™ represents a modern focal approach that is minimally invasive and safe, performed without large incisions and allowing for rapid recovery. Most patients are discharged home within 24 to 48 hours and the procedure can be repeated if necessary or combined with other treatment options.
Who are the candidates for focal therapy?
Focal therapy with NanoKnife™ is suitable for patients whose cancer is detected at an early stage and localized to a specific part of the organ. Specifically, for patients with low (Gleason score* 6) to intermediate oncological risk (Gleason score* 7) in whom the tumor is clearly visible on multiparametric MRI.
*The Gleason score is a scoring system that assesses the aggressiveness of prostate cancer and helps classify the severity of the cancer by examining samples of cancer cells under a microscope. Since the Gleason score provides important information about how likely the cancer is to grow and spread, its understanding is crucial for patients as it directly influences the decision-making process regaeding the most appropriate type and plan of treatment.
To determine whether you are a candidate for this method, the physician must confirm that the tumor is confined to the organ (i.e. no metastases), accurately localize the tumor using a fusion prostate biopsy (combining MRI and ultrasound), and assess whether your general health allows for general anesthesia.
Are there contraindications for this procedure?
Focal therapy for prostate cancer with the NanoKnife must not be performed in patients who have:
- an implanted cardiac pacemaker or defibrillator
- implanted electronic devices or devices with metal components near the ablation site
- a history of epilepsy or cardiac arrhythmias
- a recent myocardial infarction
Preparation before the procedure
Preparation for the procedure includes:
- MRI and biopsy (findings that precisely map the tumor location)
- cardiology evaluation and laboratory tests (standard blood tests, coagulation profile, and ECG)
- use of antibiotics (a prophylactic dose the day before or on the day of the procedure to prevent infection)
What does the procedure involve?
The procedure is performed under strict supervision of an anesthesiologist and a urologist under general anesthesia with the use of muscle relaxants to ensure complete patient immobility.
Under ultrasound guidance, often fused with prior MRI images, thin needle electrodes are inserted into the treatment area to surround the tumor. The system then delivers short but powerful electrical pulses over several minutes to destroy tumor cells in the prostate, while the physician monitors tissue changes in real time. After completion of the procedure, the electrodes are removed and the puncture sites are simply dressed (no suturing required).
Recovery and follow-up after the procedure
Return to daily activities is rapid, with a recommendation to avoid strenuous physical activity and heavy lifting during the first few weeks after the procedure, while walking is encouraged and recommended from the first day. Showering is permitted the following day, but bathing in tubs or swimming pools should be avoided until the needle puncture sites have fully healed.
Tissue healing capacity is individual for each patient, and complete tumor removal in a single procedure cannot be guaranteed. Since the remainder of the organ (e.g., the remaining prostate tissue) remains untreated and may theoretically develop new changes in the future, focal therapy requires disciplined follow-up after treatment.
In patients with prostate cancer, PSA (prostate-specific antigen) levels are monitored regularly, usually every three months during the first year, with a significant decrease expected. Follow-up MRI is typically performed 6-12 months after the procedure to confirm that the treated area shows scar tissue changes and that no residual active tumor is present. In selected cases, a control biopsy is recommended after one year to confirm treatment success.
In accordance with the European Association of Urology guidelines, treatment with the NanoKnife™ method is carried out in compliance with all requirements necessary for the implementation of this therapy. The data required for this purpose are collected anonymously for further monitoring and improvement of treatment quality, and the patient receives all detailed information during consultations with the responsible urologist.
Why choose NanoKnife focal irreversible electroporation (IRE)?
A cancer diagnosis and the choice of therapy represent a significant challenge. NanoKnife focal irreversible electroporation (IRE) offers the possibility of effective treatment while preserving quality of life. An open discussion with your physician about tumor characteristics, suitability of the method, and clinical experience is a key step in making an informed decision.
It is important to emphasize that the NanoKnife represents the pinnacle of precision medicine and the future of minimally invasive treatment, enabling “surgery without a knife” - targeted removal of diseased tissue with maximal preservation of healthy prostate structures. For many men, this method therefore represents the optimal balance between oncological safety and preservation of male health.
