Nanoknife

Posted by alanrittel @alanrittel, 8 hours ago

Am having Nanoknife surgery in August. The Doctor is David Strauss at University Colorado Health Anschutz Hospital. My tumor is 1mm, Gleason score 3+4 – Category 2

Wonder if anyone else has had this surgery? I hear it’s much more prevalent in Europe.

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Jeff Marchi | @jeffmarc | 7 hours ago

NanoKnife is a type of focal therapy. There are some issues you should be aware of when it comes to using focal therapy. It may be perfectly adequate for what you’re having done considering the mild case of prostate cancer you have.

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

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

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

UCSF Results: first 135 HIFU patients
 • 54% recurrence (41% in-field) 
• 4% progression by 1 year, 16% overall
 • IPSS (urinary obstruction) 6 before, 6 after 
• SHIM (erection function) 16 before, 13 after (p=0.11)
 • Major drivers of recurrence: GG3, high Decipher

Trade-offs
 • Overall focal therapy is associated with minor side effects, but high rates of recurrence
 • Inadequate energy delivery? 
• Inadequate field of treatment? 
• New cancer development? 
• Others? 
• Understanding the high recurrence rates and trying to improve them is a major area of research focus.
 • Focal therapy does not burn bridges: RP, RT, even additional focal therapy are possible if necessary

Summary thoughts 
•Focal ablation has a growing role for very carefully selected cases. 
• Side effects rates are low but recurrence rates are high. GG3 and high Decipher are warning signs, as are high PSAD and bilateral disease. 
• Focal therapy is an adjunct to active surveillance; additional treatment may well be needed down the road, but these treatments are still possible after focal.

University of California Consensus 
1 Focal therapy must be acknowledged to be investigational 
2. Focal therapy should be done under trial or research protocols as much as possible 
3. Candidates should have at least 10 year life expectancy, GG2 or low-volume GG3, stage T1 or 2, and PSA < 10 or PSA < 20 and PSAD < 0.15 
4. Candidates need an MRI-guided confirmatory biopsy before treatment 
5. Follow-up biopsy at 12 months is essential