Irreversible electroporation (IRE)?

I personally know several associates here in Canada who have had IRE - the NanoKnife procedure , All were very successful . An approximately 1-2 hour treatment , and home the same day . Minimaal to zero side effects .
See Professor Dr. Emerton , Kings College Hospital in London, England , video on NanoKnife . Multiple locations in Canada are performing this procedure -- many are in Toronto . One of my associates went to a clinic in Germany where they have performed thousands of NanoKnife procedures .
It is a growing treatment worldwidee -- slower in the USA for some unexplained reason . It's currently far outpacing TULSA-PRO.

I just saw this summary article on UroToday, which was recommended to me by @kujhawk1978 if I remember correctly. Often the articles here relate more to advanced treatments, but this was a "state of the profession" summary of focal therapies, which include IRE, TulsaPro, and a variety of others. Here is the link--I'm not sure if it works for anyone, but if it doesn't you might need to sign up or something. https://www.urotoday.com/conference-highlights/2024-south-central-section/155939-scs-aua-2024-focal-therapy-in-prostate-cancer.html
Here is the closing summary:
Dr. Meng concluded his presentation by discussing focal therapy in prostate cancer with the following take-home points:
-Focal therapy is an important tool in our armamentarium for treating prostate cancer
-There are multiple energy sources available, but overall oncologic outcomes are similar
-Focal therapy allows good preservation of continence and decent preservation of potency
-There is significant patient interest in focal therapy options, but patient selection is critical

Statistically, the statement was made: "Among patients with mostly intermediate risk disease, at 1 year 80% of patients have no significant disease, however, at 5 years 21% of patients may have to undergo an additional intervention for prostate cancer." This is a little weird, since the time frames are different but the percentages are almost symmetrical, but anyway, I get the drift. It puts off more radical treatment for most of the people for a meaningful amount of time.

The summary also makes the point that it is attractive because it provides an intermediate path between active surveillance and radical treatment, whether by radiation or surgery or both. I think that has been amply reflected in these forums over the few years I've been following them.

I think it relates to this discussion as it also helps to see how the specific pattern of identified cancer in the prostate contributes to the informed selection of which focal therapy (i.e., selective ablation or killing of cells) fits what is known about a particular presentation of cancer in the individual.

I saw IRE discussion somewhere as well, but can't find anywhere in the US that discusses doing it, and I haven't seen any discussion of it in any forums.

Here's my story about the Irreversible Electroporation (IRE) Nanoknife treatment for prostate cancer.

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 Powsang.

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 have occasional spotty leakage, like when I go to the gym or sneeze or cough. This really hasn't been a problem. Sexual function is the same now as before the treatment.

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 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. Another PSA will be done at the one-year mark.

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 the information on IRE. I am trying to get Tulsa Pro, if I don't qaulify I am going to try to get IRE.

Good luck to you! One of the reasons my doctor recommended IRE was based on the location of my tumors.

Where were they located?
How many mm were they?
Thank you for providing your experience.

Great to hear all is going well. I too wanted to do IRE and had a virtual with Dr Powsang of Moffitt. My condition and results were the same as yours. PSA 4.5, MRI guided biopsy found area of concern, 1 core of 12 found 3+4=7 in area of concern, PSMA PET and CT showed confined to one area of the Prostate. Seemed like I was a perfect condiate for focal IRE. Only difference was my area of concern is 2 cm which Dr Powsang said was too large to do focal due to desire to treat a halo around lesion. I was disappointed to hear focal wasn’t an option but glad I met with him and he gave me the truth. Looking at other options now like MRI Guided SBRT if I can find a location in Florida that does it. I don’t think Moffitt does.

I'm not all that technical, so I'm attaching the MRI report that first identified the two tumors. I hope this is useful to you.

Best wishes for finding the ideal solution for your circumstances!