Nano Knife

NanoKnife is focal therapy. Here’s the opinion of a well respected radiation oncologist about that. It may work just fine for you. It may not. Ask for the reoccurrence statistics from your doctor.

You should get a decipher test, which can tell whether or not there’s a chance of reoccurrence with your prostate cancer diagnosis.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH

What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance

Thanks Jeff,

I appreciate your input and have considered exactly what you are saying 😊

Ray & Lucy

I had the NanoKnife treatment in January 2024. I think Jeff's comments above are important to consider. Here is my experience:

The discovery of my prostate cancer began when my PSA had risen from the mid twos to over four. My urologist recommended an MRI of my prostate, which resulted in finding two prostate tumors. The tumors were both contained within the prostate. Next was a biopsy. I chose an ultrasound-guided transperineal biopsy because that type of biopsy uses the MRI information as a road map to make sure the suspected areas are tested. My biopsy showed prostate cancer in the tumors.

Based on my Gleason score of 3+4=7 and a Decipher test showing low risk, I was a candidate for active surveillance. However, one of the tumors abutted the edge of the prostate, so I chose to have the tumors treated. I didn’t want to risk the tumor spreading outside the prostate. I was not excited with the possible side effects of removing the prostate or treating it with radiation, so I did research on focal treatments.

Focal treatments focus on treating prostate cancer by attempting to kill the tumor(s) without removal or radiation. These treatments are not for everyone and seem to require that the cancer has not spread beyond the prostate. There are several types of focal treatment such as High-Intensity Focused Ultrasound (HIFU), Transurethral Ultrasound Ablation (TULSA Pro), cryotherapy, Irreversible Electroporation (IRE), and others. I chose the IRE Nanoknife treatment which uses electrical current in an attempt to kill the tumor. This treatment was done at Moffitt Cancer Center in Tampa by Dr. Julio Pow-Sang.

The IRE Nanoknife procedure went well for me. It took about an hour in total, I'm sure a good part of that was the preparation after I was put under. I think the actual procedure took about 30 minutes.

After the procedure, I had some spasms that were quickly relieved by medication. I had a catheter, which I was a bit concerned about. As it turned out, I had it for six days and didn't have any problems with it. I even removed it myself, which was surprisingly painless. I removed it in the shower so any urine that might have leaked out could be taken care of easily.

After removing the catheter, I had leakage and used pads in my underwear for about six weeks. For the first several weeks, there was blood in the urine, but that eventually cleared up. I still had occasional spotty leakage for a while, like when I sneezed or coughed, but that cleared up. This really hasn't been a problem. Sexual function is the same as before surgery.

Three months after the procedure my PSA came down from 4.25 to 2.5. Six months after the procedure the PSA was down to 1.53. A multiparametric MRI (mpMRI) was also done at six months and it showed “post ablation changes of the prostate with no new or recurrent tumor in the treatment area and no new suspicious lesions in the prostate." My doctor was very pleased with these results and deferred another prostate biopsy for the time being. At 18 months post-surgery, another MRI was done and the result was good. Subsequent PSA results are good with values of around 2.

I'm very pleased with the results so far. Best wishes to all seeking a treatment plan best for them. I would highly recommend that everyone consult with a Cancer Center of Excellence. That type of facility is equipped with the specialists, staff and technology which is particularly effective in treating cancer. In addition to Moffitt Cancer Center, which I highly recommend, I have been a patient of Mayo Clinic for many years and have always received the best of care. Both organizations are Cancer Centers of Excellence.

Thank you for your post. I am a Gleason 6 on Active Surveillance but still follow all of the treatments knowing that some day I may very well need to be treated. I too go to the Mayo Clinic in Phoenix. My urologist is Dr. Frendl. I believe he is trained in IRE Nanoknife. Please let me know how your procedure goes. I will say a prayer for you.

If the staging is correct, i.e. that the cancer is 3 + 4 confined to the prostate, this treatment seems attractive. If the cancer is not stopped, it appears you haven't lost any options, i.e. another nano knife is said to be possible, or surgical removal of the prostate, or all sorts of radiation treatment. And, it appears you haven't set yourself up for a load of side effects.

I'd look at it more carefully if I was considering it for myself, but if my doctor at a place like Mayo was recommending it I'd tend to see it as my best choice until my research indicated otherwise.

Hi Bob,

Dr. Frendl Is my Doctor as well! I feel very comfortable with him and his entire team. Glad your doing active surveillance and I am sure this is peace of mind knowing if you need additional treatment your in the best hands

Ray & Lucy

@cole5055 great! Please let me know how it goes, my prayers are with you.

Will do 😊🇺🇸

@milburnd
my husband is a candidate for this procedure, but our insurance is denying payment as “research”

I’ve always been interested in the Nanoknife - aka, Irreversible Electroporation (IRE) - technology as a form of focal therapy.

For example radiation (proton/photon) kills prostate cancer by destroying DNA, preventing prostate cancer cells from multiplying, resulting in cancer cell death. And surgery just takes out the entire prostate - both healthy and cancerous cells.

Nanoknife is a surgical ablation of prostate tissue, non-thermal, focal therapy. It uses Irreversible Electroporation (IRE) to ablate targeted prostate tissue while preserving surrounding structures.

As with other focal therapies, how do they determine if they’ve ablated all the cancerous tissue? How much margin around what they can see do they ablate?