Does anyone have any first hand experience with Nanoknife procedure?

Posted by buzzliteyear @buzzliteyear, Jul 2, 2025

I’m consider Nanoknife or cyberknife for two lesions both 3+4. From what I’ve read Nanoknife is a very successful treatment with few side effects. I’m located in the Atlanta area but willing to travel. I would greatly appreciate any experience.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

audrey27 | @audrey27 | Mar 26 7:20am

In reply to @milburnd "I had the NanoKnife treatment in January 2024. I think Jeff's comments above are important to..." + (show)

@milburnd

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.

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

brianjarvis | @brianjarvis | Mar 26 7:24am

In reply to @cole5055 "Hello All,After fighting with the VA for three years ( 100% Disabled Desert Storm 20yrs 🇺🇸..." + (show)

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?

audrey27 | @audrey27 | Mar 26 7:25am

In reply to @cole5055 "Hello All,After fighting with the VA for three years ( 100% Disabled Desert Storm 20yrs 🇺🇸..." + (show)

Any ideas on how to get BCBS to pay for IRE. We have had multiple appeals without success

jcf58 | @jcf58 | Mar 26 8:30am

In reply to @cole5055 "Hello All,After fighting with the VA for three years ( 100% Disabled Desert Storm 20yrs 🇺🇸..." + (show)

I didn’t do nano knife, but I did do a focal therapy, Tulsa Pro. My procedure was in July 2024 at the Mayo Clinic in Rochester Minnesota. I was 65 years old and Gleason 4+3. I liked the technology and the low risk of side effects. Also, Mayo said I was an ideal candidate for the procedure. I know I may have just kicked the can down the road a bit, but I’m perfectly OK with that. My thought process was that if I have to have radiation or surgery later, at least I’ve kicked those side effects down the road a bit also.

mike0157 | @mike0157 | Mar 26 3:02pm

In reply to @milburnd "I had the NanoKnife treatment in January 2024. I think Jeff's comments above are important to..." + (show)

@milburnd

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

Jump to this post

@milburnd

Hi and thank you for the info. I am considering Moffitt in Tampa. Is Dr. Julio Pow-Sang your main urologist there or just is called in for this procedure? I am looking for a reference to one of the doctors there. I am currently in AS.

Thanks
Michael

milburnd | @milburnd | Mar 26 4:34pm

In reply to @mike0157 "@milburnd Hi and thank you for the info. I am considering Moffitt in Tampa. Is Dr...." + (show)

@mike0157
Dr. Pow-Sang was referred to me by the Moffitt urologist who did my biopsy. Dr. Pow-Sang is the Chair of the Genitourinary Department. He was very responsive to my many questions. I hold him in high regard.

cole5055 | @cole5055 | Mar 27 8:47pm

In reply to @audrey27 "@milburnd my husband is a candidate for this procedure, but our insurance is denying payment as..." + (show)

@audrey27 Hi Mil,

If you have Medicare Supplement (Medigap) Plan E you can be seen by any provider of your choice. Advantage plans have a few restrictions. If you’re able to switch it would open up many new doors…….

Ray & Lucy 🙂

Jeff Marchi | @jeffmarc | Mar 27 9:39pm

In reply to @cole5055 "@audrey27 Hi Mil, If you have Medicare Supplement (Medigap) Plan E you can be seen by..." + (show)

@cole5055
The problem is, if you’ve already picked an advantage plan then getting A supplemental may not be possible if you’ve had it over a year.

Here are the details?

Trial Period Rights: If you are within your first 12 months of joining a Medicare Advantage plan, or if you left a Medigap plan to join MA for the first time, you have special "trial period" rights, making it easy to switch back.
Guaranteed Issue: If your MA plan terminates coverage or you move outside its service area, you get a 63-day "guaranteed issue" window to purchase specific Medigap policies (A, B, C, F, K, or L) without medical questions.
Underwriting Risk: Outside of guaranteed issue periods, companies can refuse to sell you a Medigap policy due to pre-existing conditions. This is common if you are switching simply because you don't like your current MA plan.
Best Time to Switch: The best time to change is during a "guaranteed issue" period, often within 63 days of losing or changing coverage

audrey27 | @audrey27 | Mar 27 9:59pm

In reply to @cole5055 "Hello All,After fighting with the VA for three years ( 100% Disabled Desert Storm 20yrs 🇺🇸..." + (show)

My husband is still working and not yet on medicare. His insurance is through employer and Blue cross blue shield of Montana is denying authorization

jim18 | @jim18 | Mar 28 4:31am

In reply to @audrey27 "My husband is still working and not yet on medicare. His insurance is through employer and..." + (show)

@audrey27 Almost all commercial insurance including Medicare Advantage will not cover focal treatments for prostate cancer (I know of none but could be exceptions). Applies to all cancer treatments considered experimental in the USA even if widely used in EU or other locations. Also unlikely to pay for Proton therapy, Fusion or mri biopsy, and even SBRT for first treatment. Plan to pay out of pocket or chose a covered treatment.
Some focal treatments are covered by classic Medicare and if Medicare pays any gap plan (G & N have replaced F & L for recent retirees) is required to pay per the policy. Gap plans regulated by CMS and do not make coverage decisions.

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