Irreversible Electroporation (NanoKnife®)
The irreversible electroporation (IRE) is a novel method for the destruction of tumor cells in the prostate by electric current.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 trials are currently underway in a total of 20 and 34 patients, respectively, which were 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 point in 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 localised prostatecancer: Nanoknife Electroporation Ablation Trial (NEAT). Contemp Clin Trials. 2014 Sep;39(1):57-65. doi: 10.1016/j.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.