Nano Knife. IRE (Irreversible Electr... - Advanced Prostate...

Advanced Prostate Cancer

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Nano Knife. IRE (Irreversible Electro Prolation. Ok. Electro Magnetic killing of PCa without damage to surrounding organs!

Spyder54 profile image

Anyone have success or experience with IRE- Nano. Knife?Finally. I have been told that surgery, and Radiation not an option due to Bladder and Rectum involvement with Prostate tumor. IRE allows for ablation of tumor without damage to rectum or bladder. Also used on kidneys and pancreas to ablate tumor without damage to organ. Basically, a double pole probe with a millisecond electro magnetic blast, perforates tumor, allowing fluid to penetrate and kill tumor. I’m looking to find a Surgeon with many procedures under their belt. Dont want to be their 3rd procedure, but 100th would be ok. nanoknife.com/technology/

47 Replies

Try Coleman at MSK.

Spyder54 profile image
Spyder54 in reply to Tall_Allen

Thank you, again TA. Yes, I had watched his video earlier in the week, and MSK is a great Center of Excellence. Will contact Dr Coleman and send up my MRI/CT Scan Discs if he thinks I am a candidate. mskcc.org/videos/irreversib...

Some background info --- it's been around for a while

wsj.com/articles/SB10001424...

" ... The NanoKnife was approved in 2008 because it was shown capable of destroying tissue similar to other existing devices that are used in heart surgery. But the NanoKnife, which isn't really a knife, was put to work treating cancer, excising malignant tumors that are near arteries, airways or other vulnerable tissues and thus difficult to remove...............

Gary Onik, a retired interventional radiologist and the NanoKnife's inventor, says he has treated about 30 patients with the device and the result "was phenomenal." All but two of the patients were cancer-free two years after the procedure, he says.......... "

Is Dr Onik retired altogether or just from IR?

That's what he used to be until going solo with the Cryo, the IRE and the Immuno.

"All but two of the patients were cancer-free two years after the procedure" I do not believe that. None of the other 28 patients had lymph node metastases causing a biochemical recurrence? At Vitus they told me they have no definition for a recurrence after IRE. So you cannot determine, using the PSA value, if a recurrence is present.

Daveofnj profile image
Daveofnj in reply to Spyder54

I met with Dr. Coleman 4 years ago. (Waited 3 hours for him to show up and he did not apologize for being late.) He told me that after NanoKnife his patients have invariably ended up with retrograde ejaculation. He said he did not understand why.

GP24 profile image
GP24 in reply to Daveofnj

At Vitus they told me that is what they expect. As far as I recall this is because the internal sphincter is ablated in the process.

cesces profile image
cesces in reply to Tall_Allen

What exactly is "NanoKnife" and "Electro Magnetic killing of PCa"

Sounds suspect unless this is just old fashioned radiation treatment?

Tall_Allen profile image
Tall_Allen in reply to cesces

Electroporation means that with a sufficient electric voltage, microscopic pores are created in cell membranes. Cell integrity is compromised, destroying it.

cesces profile image
cesces in reply to Tall_Allen

So is basically a substitute for a scalpel?

Spyder54 profile image
Spyder54 in reply to cesces

Cesces, you always ask the good questions. In some ways, with only the best Surgeon yes. But in the past, Surgeons cannot, or will not take a tumor off an organ like Pancreas or Kidney without damaging the organ. IRE Kills the tumor without damaging the organ it is attached to. Now, the Trials are trying to show with Prostate Cancer, where it is too dangerous to Cut (Scalpel😎), or freeze/cryo, or heat/Hifu because it is attached to Rectum, or Bladder that IRE may be the perfect tool. I have been told that my PCa is unrectable due to bladder and Rectum proximity. This may work to Cyto-Reduct the Mother Ship, but also has shown positive results with retro peritineal lymph nodes. I am in the investigative phase and will keep you posted.

Spyder54 profile image
Spyder54 in reply to Spyder54

Unresectable not unrectable🤬

cesces profile image
cesces in reply to Spyder54

Thanks

Tall_Allen profile image
Tall_Allen in reply to cesces

One of the scary things about IRE to me is it is very high voltage that basically electrocutes you. It has to be done under full anesthesia where heart and lungs are mechanically assisted.

Spyder54 profile image
Spyder54 in reply to Tall_Allen

Read it is 17 millisecond electronic pulses between the 2 probes with a neg and pos charge. Seems like that would keep it contained. Read up to 7 double pronged probes in one location for larger tumors. Read will not damage the nerve bundles if tumor is encasing them.

Sounds like what we need at times...good luck.

For prostate cancer most clinics will use IRE as a focal therapy, i.e. for partial gland ablation. If you get a full gland ablation IRE will also include the urethra and often damage that. IRE destroys any cells, not just tumor cells, that are in the area selected by the placement of the needles. If your tumor is too close to the bladder or rectum to be radiated you will not be able to avoid damaging these organs with IRE. The needles are placed using ultrasound imaging.

CorreaGlabra profile image
CorreaGlabra in reply to GP24

IRE is not a form of radiation therapy.

GP24 profile image
GP24 in reply to CorreaGlabra

I know, I just meant if the tumor is too close to the bladder and rectum to be radiated, it is usually also too close to be treated with IRE.

CorreaGlabra profile image
CorreaGlabra in reply to GP24

Yes, I see that now...

cesces profile image
cesces in reply to GP24

If so, then what is their advantage?

They must have some advantage in certain situations.

GP24 profile image
GP24 in reply to cesces

It is almost an outpatient procedure. After the IRE you stay in a hospital for one night for observation. So if you are self-employed you loose very few working days.

cesces profile image
cesces in reply to GP24

"It has to be done under full anesthesia where heart and lungs are mechanically assisted"

That doesn't sound like something that should be done as anything near an outpatient?

GP24 profile image
GP24 in reply to cesces

I stayed in a hotel the night before the IRE. After the IRE at Vitus and waking up, I was transported to the hospital. The next day a taxi drove me to the clinic and I got a consultation how to handle the catheter etc. Then my wife picked me up and took me back home. After two weeks the local urologist removed the catheter.

I would discuss this with different radiation oncologists who offer SBRT/SABR radiation, brachytherapy or proton beam. If one RO says he does not want to treat, other doctors may see it differently because they have different radiation systems available.

GP24. Nano Knife, not to be confused with Gamma Knife which is Radiation. Nano Knife is Electro Magnetic. It started off with use on Pancreatic Cancer where a tumor located on Pancreas could be ablated without damage to the organ. With Prostate, in most cases, they write that patient will leave hospital without need for catheter. I was thinking Cyto Reductive (not curative), but also they are having success with Retro-Peritoneal Lymph node ablation, which is often difficult to impossible with Radiation. It seems to have specific uses, which is why I was hoping some of the 14,000 on HU may share their experience.

Spyder, I had IRE done six years ago and know other patients who had it done. So I did share my experience. My treatment was no failure but I do not think it was that much better that I should recommend it to other patients. Part of the reason is that it costs a lot of money and is not covered by your health insurance. I got recurrences in both seminal vesicles and the prostate bed plus urinary retention caused by a damaged urethra.

That is why I recommended to look into radiation, if you consult seven surgeons you should consult more than one RO. If you want a cytoreductive therapy you can just ask the RO to omit the areas close to the bladder and the rectum. Tell him you want no cure, just the mothership removed.

IRE does damage organs, e.g. the prostate 😀, but you may be able to keep a distance to other organs when placing the needles. This treatment does not ablate tumor cells selectively, it will destroy any cell with the electric current between the needles.

Thanks GP24. Yes, it was not clear that you had experienced the procedure from your initial post. You were exactly who I was trying to reach. Someone who had experienced IRE Nano Knife. Much appreciated you sharing your experience, even though it was not a great experience. Everything I read presents it as a newer approach, with less than 1,000 in the US so far. I did see Germany has a 10 year track record at the “Vitus Prostate Center”.

I had IRE in Feb this year, as an adjunct to AS.

Minimally invasive is definitely correct.

I'm currently very optimistic about the results.

mpMRI will give more insight in 6 weeks or so.

CorreaGlabra, would you mind keeping us posted in 6 weeks? Was your IRE in US, or Germany, or elsewhere?

Hi Spyder was in Sydney Australia.

Re the procedure, day surgery check in at 07:00 am and was out about 13:30pm.

Catheter came out on the 3rd day afterwards.

Took Tamsulosin to help with the flow for a couple of weeks.

mpMRI at 6 months should be informative. Will endeavour to update at that time.

I had it done at the Vitus Prostate Center. All other clinics in Germany just offer partial gland ablation with IRE.

Karmaji profile image
Karmaji in reply to GP24

watch out Vitus prostatecentre in Frankfurt Germany

Have a second opinion if it suits you....It works for localised small size prostate tumor

They are highly oriented for money.......

2nd Videoyoutu.be/xiXJOYqAHoo

cesces profile image
cesces in reply to Spyder54

Thanks

A very good explanatory video.

About 11 months ago, I also had IRE done at Vitus. Sill evaluating results. PSA last July was 32, at the time of treatment in August, it was 16. Three months after treatment an MRI showed prostate much reduced in size. PSA in November was 4. The reviewing pathologist commented that the general appearance was similar to that of a patient undergoing ADT, many details were obscured and difficult to read. A second opinion on MRI results was similar and suggested that I get another PSMA scan( had one last JUne as both DR. Onik and Drs. at Vitus said it was a prerequisite. I will have one again in September at UCLA.

My cancer is/was G9, intraductal, large mass, with EPE. The MSK Nomogram suggested about a 75% chance of BCR within 5 years with either Radiation plus ADT or surgery. The advantages of IRE seemed to be, 1. a very precise definition of the ablation zone, 2. damage to cells caused by the electric field is different to that caused by either radiation or thermal ablation, 3. because of the type of cellular damage induced, all other treatment modalities should remain possibilities for future treatment, ie, the type of generalized tissue degradation seen with radiation is avoided. 4. given above considerations, reduction of tumor volume could(and not much data here) prove beneficial over the long run.

The doctors at Vitus ended up doing a variation on the IRE procedure where the current applied makes holes in the cellular membranes that are small enough for the cells to repair. At the time of treatment, bleomycin, an old line cancer drug is introduced. It penetrates the cells through the holes in the cell walls. When the cells try to divide again, they die and the dead cellular debris is carried off by normal processes. They decided on this course of treatment because of size of the tumor.

My PSA moved from 4 in November to 12 by March. Monthly tests since show it hovering around 12. Hopefully the PSMA scan will show what the cancer is doing and this will help guide the decision about the next treatment(s).

I do have urethral restriction, not enough that catheter is required. Sexual function is a little worse than before the procedure. Daily lower dose of Cialis and periodic Viagra help a lot. Haven't tried tri-mix yet. Worth mentioning that because of tumor size, surgeons at MSK and MD Anderson said that I was not a case for nerve sparing.

I had a couple of phone consultations with Dr. Onik before deciding on Vitus. Vitus has the most experience and that figured into my decision to go with them. If I had had unlimited resources, I probably would have gone with Dr. Onik as he works with combining the IRE procedure and two immunotherapy drugs. He has had some very good results with this combination, eliminating even distant metastases. The problem is that the cost of the drugs doubles the cost of the procedure. Costs that the drug companies so far have been unwilling to reduce for such an experimental low volume procedure.

GP24 profile image
GP24 in reply to FRTHBST

"I do have urethral restriction" - if you get radiation after IRE this will make things worse. If you get surgery instead, this will be a salvage operation typically with a high risk of incontinence. I would recommend SBRT after placing gold markers.

FRTHBST profile image
FRTHBST in reply to GP24

Thank you for the advice. It's eally helpful to have knowledgeable feedback.

Spyder54 profile image
Spyder54 in reply to GP24

Thanks again GP24. Like FRTHBST says….knowledgeable feedback is key.

Spyder54 profile image
Spyder54 in reply to FRTHBST

Thanks for detail FRTHBST. Did you go to the Vitus Operation in Central Florida or Germany? Also did you see TA’s post above that MSK is now doing IRE? Dr Jonathon Coleman. You mentioned you had been to MSK. One of the strengths of IRE, is that it can be repeated at same location if needed, unlike radiation. Also allows for Salvage Surgery, or Salvage Radiation. Salvage is a poor choice of words for me, as many Men have extended OS (Life) after Salvage Procedures. Best of Luck,

Mike

St Pete

FRTHBST profile image
FRTHBST in reply to Spyder54

At the time I was weighing options, MSK seemed to be applying IRE to fairly small tumors. I traveled to the clinic in Frankfurt, Germany, and was unaware of Vitus having a presence in Florida. A few years ago they tried to open a clinic in Southern California. For whatever reason it was not a long lasting venture.

Yes, the fact that one's body can take only so much radiation seemed a good reason to begin treatment with a regimen leaving the most options open for the future. This might include another round of IRE.

FRTHBST wrote --- " ... I had a couple of phone consultations with Dr. Onik before deciding on Vitus. Vitus has the most experience and that figured into my decision to go with them. If I had had unlimited resources, I probably would have gone with Dr. Onik as he works with combining the IRE procedure and two immunotherapy drugs. He has had some very good results with this combination, eliminating even distant metastases. The problem is that the cost of the drugs doubles the cost of the procedure. Costs that the drug companies so far have been unwilling to reduce for such an experimental low volume procedure."

The immuno combo used by Dr. Onik in 2015 for my GL10 consisted of 3 drugs. Slightly different application of drugs used in newer protocol.

AddictedtoCycling. Still not clear. Couple of phone consultations w Dr Onik, but assume procedure was done elsewhere?

2015 I was given the opportunity to try a "ONE OFF" immuno combo to be injected 7 months following the Hemi Cryoablated of my right half GL10. Since then the protocol has been refined. I am not sure of the current location(s) of his procedure but mine was Park Creek Surgery Center, Coconut Creek, Florida

What were the results of your treatment with Dr. Onik? Did it go well for you?

FRTHBST wrote --- "What were the results ....?"

Still on *cruise control* since having had last MRI and Axumin scans clear last year.

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