Nano knife for locally advanced prostate cancer

[Karmaji]

Like to know about Nano knife therapy for APC...

Any experience and how it is done...

Is it better than IMRT

Thanks

[Tall_Allen]

You mean as a way to ablate metastases? I guess it can be used on soft tissue mets in places where radiation might be unsafe.

[cesanon]

What is "Nano knife therapy"?

[GP24]

This article describes the procedure:

journals.plos.org/plosone/a...

You can only ablate the prostate. Since the needles are placed using ultrasound guideance they can only detect very big metastases this way. So for treating metastases I would recommend Cyberknife or IMRT radiation.

[Hidden]

I would ask 10 times "WHY?" is any knife job getting any consideration. For most of us on this journey, the ADT (hormone) treatment will drop the PSA down to 1 or below in a few weeks, and that allows the immune system to deal with the cancer cells faster than they can grow - a PSA of under 1 confirms exactly that. In the soft tissues like the prostate gland and lymph nodes, the cancer cells there may be totally eliminated (or encapsulated) over the first few months and may even show zero activity on a scan. So WHY cut out body parts that will very soon become "good" again? The same question should arise about early irradiation of the pelvic area, but there could be a good case to do so.

If you think "cutting it out" will stop the spread, you are badly informed (or you have come across someone making extra money). Little invisible colonies probably were in the bones years ago. The proof - there is no difference in long term survival numbers.

[GP24]

David,

I do not agree. If you have a Gleason 6 or 7, removing the prostate by surgery provides a very good chance of cure. You will not need to have lifelong ADT with all the side effects.

ADT is a palliative treatment. The reason the PSA value drops is that the tumor progression is stopped while the ADT works, not because all the tumor cells get killed. After a few years the tumor will become resistant and the tumor cells continue to grow. The same with all following systemic treatments, Zytiga, Xtandi etc. Except for Provenge, no immunotherapy was successfull with prostate cancer, apart from a few special cases. Our immune system has a very hard time with prostate cancer and cannot successfully attack it.

[Hidden in reply to GP24]

You are quite correct - there are many cases where a good removal job of the prostate leaves the patient "in good working order" for some years with no other treatment. A bad removal job leaves the patient in nappies. But we read in this forum many hope late removal (even inappropriate) will "get it all". We also see many cases of removal and ADT. It was the latter practice I was having a go at. I should have been more clear about that.

I must query your statement "not because all the tumor cells get killed". If a patient can keep their PSA low for a year or two, 99% of the original cancer cells will be killed by the immune system (but slow to kill new growth). Cancer in the soft tissues will get killed in weeks or months (and an enlarged prostate will shrink). Or at least they disappear from the scans which means they are either dead or essentially inactive. It takes a long time getting the job done in the bones (my observation is it takes about a year to properly "see" new growth and start effectively dealing with it). As long as the PSA remains low, the cancer is on the losing end.