Let us advise you – no matter which diagnosis and treatment you decide on.
At the VITUS Private Clinic, we will explain the advantages and disadvantages of all diagnostic and treatment procedures for prostate cancer and together we will find the best treatment option for you.
NanoKnife
A revolution in the treatment of prostate cancer
Once prostate cancer has been diagnosed, most patients are faced with a choice: Either surgical removal of the prostate (radical prostatectomy) or radiation therapy.
Both procedures are fraught with significant side effects: Impotence and incontinence. However, they by no means guarantee a cure: in most cases, prostate cancer comes back after surgery or radiation, because so-called recurrences are frequent.
Treatment with Irreversible Electroporation (IRE)
Avoid side effects such as impotence and incontinence, with comparable efficacy.
While modern, gentle treatments have long since become established in other areas of medicine, they are still a long time coming in urology. For breast cancer, the entire breast has not been amputated for a long time, but the tumor is removed focally. In renal cell carcinoma, if possible, not the entire kidney is removed, but only the tumor – the healthy part of the kidney is preserved. The prostate is still removed “radically”, i.e. completely, in most cases unnecessarily.
This has changed since the successful introduction of Irreversible Electroporation (IRE) for the treatment of prostate cancer. With IRE, prostate cancer can be focally destroyed, with a lower likelihood of side effects.
The wide range of IRE treatments
From focal therapy of small carcinomas to a problem solver for unresectable T4 carcinomas.
IRE – also known by the product name NanoKnife – enables the gentle treatment of prostate cancer while avoiding impotence and incontinence.
IRE can be used to treat the full range of prostate cancers – from small focal carcinomas to T4 tumors that have already infiltrated the bladder or rectum – in other words, inoperable, usually advanced cases1.
Our most important message:
Do not allow yourself to bepressured into
treatment
At VITUS, we provide you with detailed information about all treatment options.
Prostate cancer often progresses slowly. In most cases, you will have enough time to learn about all treatment methods. In addition, classical “radical” therapy (surgery and/or radiation treatment) rarely prolongs life expectancy in low-aggressive prostate carcinomas – and in highly aggressive carcinomas, according to available statistics, it does not do so in many men. The same applies to radiation therapy. At the same time, the classical treatments mainly lead to serious side effects, rarely to cure: 70-80% of all men experience erectile dysfunction after surgery, and 20-50% of patients experience urinary incontinence (Table 1).
RT
3,2%
4,4%
9,4%
RT
60,8%
71,9%
93,9%
bowel function
RT
34,0%
31,3%
35,8%
Table 1: Long-term sequelae of radical prostatectomy (RPE) and radiotherapy (RT) for prostate cancer regarding incontinence, impotence, and impaired bowel function. Table translated into German by Resnik MJ, Koyoma T, Fan K-H, et al. N Engl J Med 2013; 368:436-45.
The NanoKnife process
The NanoKnife tissue ablation procedure is a novel therapy that uses Irreversible Electroporation (IRE) to destroy cells. The surrounding tissue is not injured in the process. Prostate cancer can be treated for the first time with this method in such a way that continence is preserved and there is only a low risk of impotence. In addition, the NanoKnife procedure has a very low likelihood of pain or scarring. Here at VITUS, we are proud of the pioneering work we have done with the NanoKnife process. We are among the world’s leading experts in the use of IRE in the treatment of prostate cancer.
Through our close collaboration with the inventor of IRE for medical purposes, Prof. Boris Rubinsky of the University of Berkeley in the USA, we have had the opportunity to study and understand IRE at all stages of development, from laboratory to animal studies to human application. Our physicists and physicians are thus among the pioneers and world’s leading experts in electroporation processes – both in the scientific-technical field and in clinical use.
ADVANTAGES OF THE NANOKNIFE TREATMENT AT A GLANCE:
- One time treatment in only one day
- Highest potency retention rate achieved to date*.
- Statistical 0% Incontinence**, ***
- No surgical incisions, no pain
- No aftercare necessary
- No higher recurrence rate than radical procedures**.
- Treatment even after prostatectomy or radiotherapy
- Secondary immunological effects
*Urinary incontinence, as it is called, is the lack or inability of the body to safely store and self-directly empty the contents of the bladder. This leads to involuntary loss of urine. While there are several possible definitions of incontinence, a long-term study of incontinence after prostatectomy** concludes that a reasonable definition of incontinence is when a patient requires 2 or more pads per day 12 months after prostate surgery.
** Sacco E, Prayer-Galetti T, Pinto F, et al. Urinary incontinence after radical prostatectomy: incidence by definition, risk factors, and temporal trend in a large series with a long-term follow-up. BJU Int. 2006;97:1234-41.
*** Syan, Raveen, and Victor W. Nitti. “Post-prostatectomy Incontinence Initial Evaluation.” Urinary Dysfunction in Prostate Cancer. Springer, Cham, 2016. 15-30.
NanoKnife technology
ideal for the treatment of prostate cancer
The NanoKnife process is based on ultra-short pulses that generate strong electric fields. The pulses are 100 microseconds long – i.e. 0.0001 seconds. Compared to standard procedures, this new technology has unique features that make it ideal for treating the prostate.
- Tissue selectivity: Only cells that have a cell membrane, such as cancer cells, are reliably destroyed. All other structures, such as nerves, blood vessels and connective tissue structures, remain intact.
- Ultrasharp edges: With NanoKnife, the area between completely removed and untreated tissue can be measured in micrometers. This clearly sets NanoKnife apart from other treatment methods, such as radiation therapy, heat-based treatments and even surgery. In these methods, the central treatment field is always surrounded by an area where the tissue is unintentionally damaged. Often this is a zone with a diameter of several centimeters.
- Programmed cell death: NanoKnife causes cell death (apoptosis) to occur without causing radiation damage or burns and without forming scars. Current standard methods, such as radiation therapy (proton therapy, brachytherapy, etc.) and heat therapy (HIFU, microwave therapy, etc.), always create a large “toxic” area because the burned tissue is toxic to the body. The result is inflammation and pain with subsequent scarring. All of this prevents or limits further treatments that may be needed in the event of a recurrence.
- Repeatable any number of times: Since IRE treatment does not lead to long-term tissue damage, all other treatment methods (radiotherapy, heat, surgery) can continue without restriction after NanoKnife treatment. In addition, treatment using IRE can be repeated as often as necessary.
- Painless and minimally invasive: because no tissue is damaged by burning or radiation. In addition, only thin needles are used as invasive instruments. Thus, our patients usually hardly notice the treatment.
- Fast and in one session: Even extensive areas can often be treated under general anesthesia in just one session.
- Wide range of possible applications: The treatment of small, early detected prostate tumors is definitely the simplest application of NanoKnife. However, NanoKnife is also a treatment option for inoperable carcinomas that have already breached the prostate capsule, as well as for the treatment of recurrences that occur after radiation therapy, radical prostate removal, HIFU or brachytherapy.
- Immune system: The tumor fragments released during NanoKnife treatment support the patient’s immune system in fighting further tumors.
Precision determines the success of therapy with NanoKnife
Since 2007, the IRE technique has been approved by the FDA in the USA and CE marking in Europe. This was done because corresponding studies prove that all cells within the treatment area can be killed with this method. In order to achieve this and carry out a successful IRE treatment, two factors are crucial:
- Firstly:
the exact position of the tumor must be known before treatment. - Secondly:
the treatment field must be placed in exactly the right position.
The first condition is fulfilled by multiparameter MRI examination, 3D biopsy and, if necessary, other procedures. The second condition is fulfilled by a minimally invasive procedure under general anesthesia. Sterile needles with variable exposure length are inserted. “Exposure length” refers to the area of the needle that exposes the tissue to electrical current. We have experience with this procedure since 2011 and have performed the most prostate treatments worldwide. This makes us one of the leading experts worldwide, while other clinics are just getting started.
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to arrange a consultation.
+49 (0)69 50 50 00 950
What is behind the IRE?
The biophysics of the method
Non-thermal tissue ablation using strong electrical pulses
Electroporation processes were used in the food industry as early as around 1958 by Doevenspeck in Germany2.
When cells are exposed to strong electric fields, pores (small holes in the cell membrane) form, perforating the cell membrane (Figures 3 and 4). In the case of irreversible electroporation, these pores do not close again. This makes the cell dysfunctional, triggering what is known as apoptosis, a “suicide mechanism” of the cell.
Necrosis mechanisms are also involved in cell death by Irreversible Electroporation .
The electric fields are generated by very short electric pulses, typically 100 microseconds long. Due to the short duration of the pulses, heating of the tissue can be largely avoided.
Clinical application of IRE?
The right technique is crucial for good results
As with many other medical treatments, the technical details of IRE treatment determine its success, i.e., the reliability with which the tumor is destroyed and the side effects triggered by the treatment.
Unfortunately, no technical standards have been established for IRE treatment of the prostate. That is, each physician performs IRE treatments at his or her own discretion using his or her own technique. Most urologists therefore use a grid, also known as a brachytherapy grid, for the placement of the electrodes, which they know from brachytherapy and which is used there for the insertion of the radioactive seeds.
