NanoKnife: Efficacy not proven
The irreversible electroporation (IRE) is a novel method for the destruction of tumor cells in the prostate by electric current. Strong, localised electric fields cause tiny pores in the cell walls, which leads to the death of tumour cells in the treatment area. The IRE is a focal therapy of the prostate gland in which not the entire organ but only areas suspected of being tumor are treated.
Disadvantages of irreversible electroporation with the NanoKnife:
The irreversible electroporation with the NanoKnife is an experimental treatment method for prostate carcinoma. Randomized multi-center studies and long-term experience are still lacking. Two clinical studies are currently underway in a total of 20 and 34 patients, respectively, which have been investigated over a period of 6 and 12 months. 1/2 Due to the small number of patients and the short follow-up period, it is not possible to make valid statements on the effectiveness of the procedure at this time.
Focal therapy of the prostate makes sense?
If therapy is necessary due to tumor size, aggressiveness and/or extension, it is recommended to treat not only individual tumor centers but the entire prostate. Especially in the case of medium and higher risk prostate carcinomas, it is important to destroy all tumor cells in order to minimize recurrence of the disease (recurrence).
Wait and see instead of NanoKnife
For this reason, the IRE is currently mainly used in patients with low-risk prostate carcinoma, which can be assigned to active surveillance according to the recommendations of the current guidelines. In the case of a "premature" therapy with the NanoKnife, there is a risk of "over-therapy".
Since the proof of efficacy of irreversible electroporation is missing, the method is not adopted by private and statutory health insurance companies. The costs to be borne are between 15,000 and 20,000 euros.
Valerio M et al.: A prospective development study investigating focal irreversible electroporation in men with localized prostatecancer: Nanoknife Electroporation Ablation Trial (NEAT). Contemp Clinical Trials. 2014 Sep; 39 (1): 57-65. doi: 10.1016/y. cct. 2014.07.006. Epub 2014 Jul 26.
Valerio M, et al.: Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer. Prostate Cancer Prostatic Dis. 2014 Sep 2. Doi: 10.1038/pcan. 2014.33.