I haven't heard of this treatment before but the results look good; see urotoday.com (19 April)
"The results indicate comparable efficacy of IRE to standard radical prostatectomy in terms of 5-year recurrence rates and better preservation of urogenital function, proving the safety and suitability of IRE for PCa treatment. The data also shows that IRE, besides focal therapy of early PCa, can also be used for whole-gland ablations, in patients with recurrent PCa, and as a problem-solver for local tumor control in T4-cancers not amenable to surgery and radiation therapy anymore."
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Bjry
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I do not know. The FDA has approved the equipment.
"FDA: The NanoKnife is intended for the surgical ablation of soft tissue in the United States. The FDA has not cleared the NanoKnife System for the treatment of any specific disease state or condition.
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You can search for places using the equipment in the USA in this page:
This article is basically an advertisment for this treatment. All the authors work for Prof. Stehling who runs the clinic in Germany that offers IRE. The exception is Dr. Rubinsky who developed this treatment. This treatment is not payed by your health insurance so they have to advertise a lot.
The data in the article is based on the patient records they have in their clinic. So I would not trust e.g. the recurrence results that are presented. A lot of patients consult their local doctor after the IRE treatment and therefore the authors of the article do not get reports of recurrences. But the treatment is usually successful. The main side effect is urethral stricture which happens in maybe 30% of the treatments. This can require a TURP after the IRE treatment.
The treatment is great for self-employed patients since you get the treatment on one day, stay at a hospital for observation for one night and then you can have someone drive you home the next day. You will have a catheter then, but you can sit at your desk and do some work. They will also do the treatment if you have mets and the standard of care is ADT and not a local treatment. So if you would prefer to have the primary tumor treated, you can do that with IRE. It is also offered as a focal treatment.
There is a clinic in San Diego offering the IRE treatment in cooperation with the main clinic in Germany:
Based on 2 days knowledge I’m a long way short of being an expert on this treatment and I fully agree you need to be sceptical about any treatments. However in a free enterprise economy I’m not offended or concerned when people use research data to advertise a product. Manipulating data to make false or misleading claims is another matter. In some jurisdictions this could lead to substantial fines and professional sanctions.
The article shows Dr Rubinsky works at the Department of Mech. Engineering, University of California Berkeley, Berkeley, CA, United States of America. Personally I’m satisfied this is a reasonable guarantee that the data in the report has been honestly and fairly reported. The equipment is approved by the FDA but not approved for any specific condition. I also know the treatment is available in a number of other countries – in Australia at least IRE is available at some independent medical centres with no obvious business links to Prof. Stehling. If the good Professor advertises a lot he should link up with a better advertising agency – I’ve read a lot since diagnosed with stage 4 PCa 9 months ago and I have never heard of the product before.
At the present time foe me this discussion is academic – as far as I’m aware the cost of treatment isn’t covered by insurance or by any public health system. I couldn’t find any published cost of treatment but I have very recently seen one report claiming the cost ranged from 13,000 to 18,000 English Pounds. That’s way out of my league.
There has been at least one Phase1/2 completed clinical trial - ClinicalTrials.gov Identifier: NCT01939665 but I couldn’t find ant published results. The Cancer Council of Victoria (Australia) has a pilot surgical trial underway to examine “The safety and efficacy of Irreversible Electroporation for the ablation of prostate cancer assessed by procedural related side effects and post prostatectomy histology”. I’ve also found a Chinese Phase 1/2 study at ClinicalTrials.gov Identifier: NCT02430662. The use of IRE in England for pancreatic cancer is reported at pancreaticcancer.org.uk/inf.... Another study involves analysis of 2000 PCa patients from various countries who were or will be treated with IRE - see NCT02255890.
I have no idea if there are other trials are underway but personally I’m satisfied IRE is a bona fide technology that MAY even now be relevant for some PCa cases (at least for people with a lot deeper pockets than mine). For me IRE is a matter of wait for clinical trials to confirm the technology does work on prostate cancer and for the Australian Government to put IRE on our PBS/Medicare list of approved treatments.
In your situation I definitely would try to get a Lu177 treatment. The IRE will treat the prostate but not all the metastases you have. These are the real threat for you. The following trials have not yet started but you can see that they try to use the treatment early now:
In Germany there are clinics which would treat you now if you present with the wide spread tumor you describe. However, the cost will be way out of your league again. Maybe you will find one for you in Australia as well:
I never saw IRE as too relevant to my situation. I commenced the standard “one size fits all” PBS/Medicare regime of Zoladex on 31 July 2018 and 6 sessions of Docetaxel began on 12 September. Luckily the ‘one size’ fitted me very well. My PSA was 152 in early July 2018, after 6 Docetaxel cycles my PSA reduced to 0.25 in January 2019. An MRI and whole body bone scan in February confirmed a significant reduction in my detectable tumour burden. My oncologist described my response as “excellent”.
I had read some of the links to Lutetium 177, but the only bad news about being Hormone Sensitive is that all of the trials relevant to my circumstances only accept people who are Castration Resistant. Perhaps the new funding will extend eligibility to hormone sensitive cases; I’ll definitely keep watching.
I‘d like to stay on the front foot treating this disease and keeping on with Zoladex alone is a very defensive strategy. I’d be very happy if Lutetium 177 becomes an option. I’m in a continuing conversation with my oncologist about which pathway is most likely to give me a reasonably healthy life for the longest time. Probably this is one of those things where no one can be sure of the best answer and the best answer today will be overtaken within 12 months, hopefully by the science rather than my disease progression.
I had this done in San Diego a year ago. I had Gleason 8, PSA 8, MRI that showed all within the prostate (or as best as we can determine).
F/U PSA/MRI every six months, with the first PSA being a new baseline, as this was a focal treatment.
That PSA was 3.55, subsequent one recently was 3.0 and 2.5 (two labs).
MRI has been stable. PI RADS 2 both times.
Had no sx; this was all lab driven.
No incontinence, impotence.
Felt that a focal treatment could be of benefit, that the procedure made sense and the practitioners had experience. Getting IRE does not preclude other treatment. IRE can be very precisely aimed so structures that you don't want affected can be avoided, which may explain their ability to avoid impotence and incontinence. This was done as an outpatient, but general anesthesia and paralytics were used.
And, yes, you have to pay for it without aid from Medicare or Insurance. In my case was the price of a new small car, and I have tried to think of it that way.
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Any taking ADT see a reason not to do this?
CRPC - causes and prevention of 
