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Nanoknife proceedure

User
Posted 06 Feb 2020 at 16:43

Hi I’ve recently been diagnosed with prostate cancer. I have showed no symptoms of prostate cancer and found out because did a psa blood test which was 13. I then underwent a template biopsy which resulted in a Gleason score of 4&3. I’ve had a bone scan which thankfully has come back negative for any spread of the cancer. I have been researching various treatments and the Nanoknife proceedure has very good results. I have offered the robot assisted prostate removal but I’m worried about the after effects as Im only 53 and don’t want to end up ED or incontinent. Has anyone had or heard of the Nanoknife proceedure. Also can anyone give some information about the robotic assisted operation that is worrying me sick at the moment.

many thanks.

User
Posted 06 Feb 2020 at 22:07

My husband was 53 at diagnosis in 2016 and felt the same as you re avoiding side effects if possible . 
His diagnosis was a large G6(3+3) so low risk. We were not offered Nanoknife as a primary treatment but we wanted a focal treatment so traveled to Florida for an FLA. This gave us three years but an increase in his PSA last summer led to a MPMRI (PIRAD 4} and a biopsy coming in with a Gleason 7 (3+4).

 

so we stuck with our focal preference and he has had focal HIFU 2 weeks ago. He has no incontinence and is recovering his erection. However the big question is whether the cancer is controlled. He gets the results from his post HIFU MPMRI on Monday.

 

User
Posted 06 Feb 2020 at 22:14

Hello Carlos,

Welcome to this forum though sorry it is PCa that brings you here.

As regards Nanoknife, which is Irreversible Electroporation (IRE), you are considering is a form of treatment where there is no medium to long term knowledge of outcomes because it is a relatively new form of treatment. I think we have only had one member who has been treated with it on this forum. It is a treatment that was largely done abroad although I believe there may be a small number of places where it can be done in the UK but quite possibly only privately unless within a trial. No doubt you have investigated this aspect. There is a pretty comprehensive report by NICE on studies that have been undertaken and short term analysis of IRE together with a caution about it's use being carefully considered. I suggest you look at this as it will provide more information than you will receive from members here due to it's rarity https://www.nice.org.uk/guidance/ipg572/documents/overview-2

Are you concerned about Prostatectomy as a treatment in general or is it the robot assisted procedure that particularly concerns you? There is very little to choose between the forms of surgery in terms of ultimate success and sometimes there is an advantage for some men in having the more conventional open surgery. However, the robotic method has gained in popularity among hospitals and patients because recovery is quicker and patients appreciate smaller incision marks.

I think you will find it of benefit to obtain the 'Tool Kit' which can be downloaded or a hard copy obtained from this Charity. It will give you a better understanding of Prostate Cancer (PCa) and treatment options. https://prostatecanceruk.org/prostate-information/our-publications/publications/tool-kit?_ga=2.206109653.795867346.1564408880-1013787081.1564408880


You must be aware that due to their diagnosis and other possible contraindications, not all men are suitable for every type of treatment, furthermore not all hospitals are able to offer all types and ways of treating, so some men opt for treatment in another hospital where permitted within the NHS or where they decide privately.

Edited by member 06 Feb 2020 at 22:22  | Reason: Not specified

Barry
User
Posted 07 Feb 2020 at 09:54
There was a NanoKnife trial in London carried by Professor Ecannotbenamedhere, on the NHS, but the results were inconclusive, which is why it is not offered as an NHS procedure. I think he charges around fifteen grand privately, depending on how many electrodes (@ £400 a pop) they need to use.

There is a centre of excellence for the procedure in Offenbach (my nick-name for my German Shepherd) near Frankfurt in Germany, which no doubt you have already Googled. It might be worth obtaining an opinion from them regarding your condition, but I doubt if your European Health Insurance Card will cover the cost.😉😂😂

If you check on the Macmillan Cancer Care website forum, I think there are one or two guys who have had it done on there.

Best of luck.

Cheers, John.

User
Posted 07 Feb 2020 at 10:04
Hi Barry,

Thanks as ever for your informative link to those medical trials. I note one of the NanoKnife patients had a post-op complication when an abscess formed in his epididymis.

The comment that it was resolved by a ‘simple orchietomy’, seems somewhat understated!

Cheers, John.

User
Posted 07 Feb 2020 at 16:50

Hi Barry

Thanks for the reply and the useful info as your aware all of this is a bit new to me and I’m still trying to come to terms with my diagnosis let alone the treatment. I’m leaning toward the robotic assist surgery at the min, the only hurdle is the timing. I was supposed to see my surgeon middle of Jan and the op scheduled for end of February, we have along overdue and very exciting holiday booked for this July. As it stands now I’m booked to see my surgeon 28th February and not really sure when the operation would go ahead, even if it was end of March this doesn’t give me time to get well and back to a degree of health I’d like before travelling. 
I have been toying with the idea of asking the surgeon to schedule the operation after we return from our holiday. My wife is a teacher and will be off for the school holidays in the summer so will be home to help me get well if needed. At least then we can relax in the coming months, enjoy the holiday as a complete man, if you know what I mean and then go for the operation middle of July.

What are your thoughts on this ? I would welcome any input at all, as at the moment I feel pretty alone and confused. 

kind regards

 

Carl.

User
Posted 07 Feb 2020 at 16:58

Hi thanks for the reply, can I ask how is your husband now ? The indecision is killing at the moment some guys say go for radiotherapy for now and wait and see, most guys including professionals recommend the robotic assist surgery. I have been married for 4 years and I’m more worried about the impact of the side effects on my wife and my marriage, even though she has been amazingly supportive she didn’t marry a man with erectile disfunction  or one that will wear a Tener men’s 😅. I have decided almost 99% to go ahead with the robotic assist surgery but one day I’m all for it then the next day I want to run away and ignore the cancer.

User
Posted 07 Feb 2020 at 23:54
You have not shown your staging and what the cores revealed so we don't know how much cancer is in your prostate, things that could affect urgency to treat and any other options. Any treatment has possible side effects and not doing anything may mean the cancer progresses and shortens your life. It might be that you might be a suitable candidate for a treatment that has milder side effects than surgery or radiation. This is HIFU, (High Intensity Focal Ultrasound). You would have to get an opinion on whether you are a suitable candidate for this procedure which can be repeated in need or followed either by RT or Prostatetectomy. Long term results are not yet known and success rates as a primary treatment may be not quite so good as the other aforementioned treatments but could buy you more time at least as an interim measure. You might have to have this done privately as this treatment on the NHS is generally given as a salvage treatment for failed Radiotherapy treatment within a trial.

A treatment decision where options are available is one that probably most men struggle to make. You usually have to make your own decision based on how you prioritize the potential pros and cons of various treatments for your specific case . I again suggest you refer to the 'Tool Kit' in the link I previous gave to help you with this decision if you have not yet done so.

As regards your wife's attitude, this is something you should consider discussing with her. PCa is considered a couples disease.

Barry
 
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