Re: Nano Nano Nano

[Guest guest]

Milt wrote:

....

> However, assuming a patient can afford to pay for IRE/Nanoknife

> treatment, are there good reasons to avoid going the

> IRE/Nanoknife route today? If so, what are they? What am I

> missing?

If it were me, I would avoid it unless I were more interested in

advancing medical research than saving my life. That might be

the case if I were 85 years old and ready to go, but if I were

younger it probably wouldn't.

Here are some issues that I foresee:

1. We don't know if it works.

That's a big issue. Cryosurgery and HIFU were hyped to the

sky but, as I understand it, actually turned out to be

significantly less effective than conventional surgery or

radiation therapy in controlling cancer.

2. We don't know if the side effects are better or worse.

As I understand it, cryotherapy had a much higher rate of

negative side effects, at least in its earlier

implementations, than conventional treatments. If I remember

correctly, 100% of men undergoing cryo to the entire gland

turned out to be completely and irreversibly impotent.

3. There are no experienced physicians offering it.

If only 300 patients have been treated worldwide, then there

can't be any physicians with much experience. But experience

is extremely important in any medical procedure.

4. Every treatment needs refinement.

New procedures require a lot of study and experience before

anyone knows the right way to apply them. This was certainly

true for surgery, all forms of radiation, cryosurgery and

HIFU. It takes years of experimentation to learn the best way

to apply a procedure. IRE has not had that experience.

In today's world of high tech we often imagine that newer is

always better. Beware! It isn't true. In the medical world it

is usually the case that newer is worse. Only a very small

percentage of new treatments and new drugs turn out to be as good

as the treatments and drugs they aim to replace. And it takes

years to find out which ones really are better.

If the conventional treatments were all unlikely to work and had

terrible side effects, I might take a chance on leaping into the

unknown. But in fact the conventional treatments do work. Side

effects are still a crap shoot. Many men experience permanent

impotence and many experience permanent incontinence or other

side effects. It's a serious problem. But we don't really know

what the side effects of IRE are and whether they are really

better or worse.

So, if you want to advance the science, go for it. If you want

the best odds for cancer control and reduced side effects, go for

conventional treatment. You might luck out with IRE, but the

odds are against it.

Finally, I imply from your posting that you have a Gleason 6

cancer. Depending on your other disease parameters - PSA, stage,

number and percentage of positive biopsy cores, age, it's

possible that you don't need treatment at all at this time.

Best of luck.

Alan

[Guest guest]

Another question is what happens if it fails, what can then be done.

Some people have to be brave and try new procedures, it is like Edmund and Tenzing exploring the top of Everest or Neil Armstrong steeping on to the moon.

Are you going to be an adventurer or take the well trod path?

Nano Nano Nano

As a newly diagnosed prostate cancer patient with what appears to be small, slow-growing tumor*, I've read Dr. C. McHugh's book, The Decision, Dr. Scardino's Prostate Book, and about five others on prostate cancer--steep learning curve! I'm still gathering information and searching for answers, and my search gives rise to this post.According to the Wall Street Journal (10-10-2010), the NanoKnife is being used in over a dozen U.S. hospitals and in a handful outside the US, and it has treated about 300 cancer patients worldwide. However, the device has yet to endure the rigorous process of randomized, controlled clinical trials thanks to a loophole of sorts that permits FDA approval to medical devices without trials if they resemble another device already on the market (the NanoKnife shares characteristics with medical devices used in heart surgery). Doctors who have used the device say it has saved lives, including among prostate-cancer patients.I'm a layman, not a medical professional, but based on my research it seems to me that irreversible electroporation (IRE) with the Nanoknife might just offer a Get-Out-of-Jail-Free card to at least some newly diagnosed prostate cancer patients who are Gleason 6 or lower. The bad news is that unlike the competition (open or robotic radical prostatectomy, many different kinds of radiation treatments, cyro and HIFU to name the leading choices), IRE doesn't have a long-term record with prostate cancer and the Nanoknife has not been approved by the FDA for use on anything other than surgical ablation of soft tissue. Moreover, as far as I know Medicare and most private insurance will not cover prostate cancer Nanoknife procedures. But it seems to me that the very good news about prostate cancer treatment by IRE with the Nanoknife is that:• The procedure is minimally invasive.• The prostate and all nerves and blood vessels remain intact.• Tumors up to 5cm can be treated, ablated, and removed. • In the hands of experienced interventional radiologists and done properly, the procedure actually kills all the cancer imaged during treatment. • Patients experience little pain during or following the procedure.• Treatment requires only a brief hospital stay, usually one day or less.• The procedure can be repeated if PSA goes up/new lesions develop.• IRE causes no known "big deal" long- or short-term side effects such as incontinence, scarring, or loss of sexual potency.• If the treatment fails, more conventional treatments are still optionsIt's true that being among the first isn't normally to be recommended when it comes to medical treatments. On the other hand, it seems to me that IRE/Nanoknife treatment may be a court of first resort—a procedure for a newly-diagnosed prostate cancer patient like me to try first. After all, it may well be that IRE treatment will completely remove the tumor. Even if it doesn't, evidence shows that it can slow down the growth of the cancer by reducing the size of the tumor and—as with the Get-Out-of-Jail-Free card in Monopoly—allow a few more trips around the board.To be sure, it'll be a long time before IRE with the Nanoknife is accepted by the medical establishment as a front-line treatment for prostate cancer, something that should come only after randomized studies that look at short-term and long-term cure rates and complications. However, assuming a patient can afford to pay for IRE/Nanoknife treatment, are there good reasons to avoid going the IRE/Nanoknife route today? If so, what are they? What am I missing?Thanks,--Milt*Diagnosed 1/31/2011 at age 70, otherwise in excellent health, PSA 3.3 up from 2.8 eight months before, biopsy shows one core of six [70% of the core sample] as adenocarcinoma, Gleason 3+3; remaining five core samples clear; "equivocal" ulstraound shows prostate estimated at 81cc with questionable nodule in mid-left side measuring 15mm in diameter, and says seminal vesticules are normal; DRE felt asymmetry with a "ridge" on the left side, but urologist was uncertain whether the ridge is the tumor; stage questionable either T1c or T2a. Headed to Mayo Clinic in ville, FL for full consultation next month.

[Guest guest]

Milt, with only one core out of six being cancerous, and the doctor saying the cancer is small and slow-growing, it seems to me you would be an idea candidate for active surveillance. Why even consider an experimental treatment at this stage?

Mike

Subject: Nano Nano NanoTo: ProstateCancerSupport Date: Saturday, February 26, 2011, 4:01 PM

As a newly diagnosed prostate cancer patient with what appears to be small, slow-growing tumor*, I've read Dr. C. McHugh's book, The Decision, Dr. Scardino's Prostate Book, and about five others on prostate cancer--steep learning curve! I'm still gathering information and searching for answers, and my search gives rise to this post.According to the Wall Street Journal (10-10-2010), the NanoKnife is being used in over a dozen U.S. hospitals and in a handful outside the US, and it has treated about 300 cancer patients worldwide. However, the device has yet to endure the rigorous process of randomized, controlled clinical trials thanks to a loophole of sorts that permits FDA approval to medical devices without trials if they resemble another device already on the market (the NanoKnife shares characteristics with medical devices used in heart surgery). Doctors who have used the device say it has saved

lives, including among prostate-cancer patients.I'm a layman, not a medical professional, but based on my research it seems to me that irreversible electroporation (IRE) with the Nanoknife might just offer a Get-Out-of-Jail-Free card to at least some newly diagnosed prostate cancer patients who are Gleason 6 or lower. The bad news is that unlike the competition (open or robotic radical prostatectomy, many different kinds of radiation treatments, cyro and HIFU to name the leading choices), IRE doesn't have a long-term record with prostate cancer and the Nanoknife has not been approved by the FDA for use on anything other than surgical ablation of soft tissue. Moreover, as far as I know Medicare and most private insurance will not cover prostate cancer Nanoknife procedures. But it seems to me that the very good news about prostate cancer treatment by IRE with the Nanoknife is that: • The procedure is

minimally invasive. • The prostate and all nerves and blood vessels remain intact. • Tumors up to 5cm can be treated, ablated, and removed. • In the hands of experienced interventional radiologists and done properly, the procedure actually kills all the cancer imaged during treatment. • Patients experience little pain during or following the procedure. • Treatment requires only a brief hospital stay, usually one day or less. • The procedure can be repeated if PSA goes up/new lesions develop. • IRE causes no known "big deal" long- or short-term side effects such as incontinence, scarring, or loss of sexual potency. • If the treatment fails, more conventional treatments are still optionsIt's true that being among the first isn't normally to be recommended when it

comes to medical treatments. On the other hand, it seems to me that IRE/Nanoknife treatment may be a court of first resort—a procedure for a newly-diagnosed prostate cancer patient like me to try first. After all, it may well be that IRE treatment will completely remove the tumor. Even if it doesn't, evidence shows that it can slow down the growth of the cancer by reducing the size of the tumor and—as with the Get-Out-of-Jail-Free card in Monopoly—allow a few more trips around the board.To be sure, it'll be a long time before IRE with the Nanoknife is accepted by the medical establishment as a front-line treatment for prostate cancer, something that should come only after randomized studies that look at short-term and long-term cure rates and complications. However, assuming a patient can afford to pay for IRE/Nanoknife treatment, are there good reasons to avoid going the IRE/Nanoknife route today? If so, what are

they? What am I missing?Thanks,--Milt*Diagnosed 1/31/2011 at age 70, otherwise in excellent health, PSA 3.3 up from 2.8 eight months before, biopsy shows one core of six [70% of the core sample] as adenocarcinoma, Gleason 3+3; remaining five core samples clear; "equivocal" ulstraound shows prostate estimated at 81cc with questionable nodule in mid-left side measuring 15mm in diameter, and says seminal vesticules are normal; DRE felt asymmetry with a "ridge" on the left side, but urologist was uncertain whether the ridge is the tumor; stage questionable either T1c or T2a. Headed to Mayo Clinic in ville, FL for full consultation next month. ------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at

all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

[Guest guest]

All other treatments appear to have moderate to severe side effects.

Nanoknife claims not to. The doctors should know by now what the short

term side effects are.

Seems to me the most difficult part of this is getting the proper

electrode placement.

All the treatments are a crap shoot. At least Nanoknife appears to have

minimal short term side effects, no radiation, and no major surgery.

Doug

[Guest guest]

dtc wrote:

> All other treatments appear to have moderate to severe side effects.

> Nanoknife claims not to.

Ah, there's the rub, " ... claims not to. "

I hope it's true but I've seen the same claim by unscrupulous

practitioners of every other treatment, without exception.

For example, people have reported in patient support groups that

their surgeons told them that 98% of their patients are continent

and potent after surgery. When the patient comes out incontinent

and impotent it's, " Oh bad luck old fellow. You're in the 2%. "

I don't believe claims by doctors. I want to see hard numbers

from an independent survey of actual patients.

I'm not saying that IRE isn't a good treatment. I'm not even

saying that its claims are false. I'm only saying that the

evidence isn't in yet. And I'm also saying that we've had a lot

of experience with new treatments that were claimed to be

superior to standard treatments only to find out that the claims

weren't true.

Anybody opting for treatments that have not been proven yet

should do so with their eyes wide open.

Alan

[Guest guest]

Doug,

No one knows what the long term average 10 year disease free

rate or serious side effect rates will be for Nanoknife; but numerous

peer reviewed medical journal reports provide that same data for

treatments

that have been around for over 10 years - and they are all not the same.

A summary of the best PCa average 10 year disease free (DF), treatment

failure (TF) and serious side effect rates with an overall PCa

treatment failure figure of merit (FFM) is listed below. If you want a

copy of the associated comparison report (and references) just send me

an email.

Treatment; ASTRO, 0.2 ng/ml, DF; TF,

Urinary, Rectal, Sexual**, FFM

Seeds>IMRT; na, 83%, 83%; 17%, 1%, 0%.

19%. 37

IMRT>Seeds; 81%, na, 69%*; 31%*, 1%, 0%, 25%, 57

Seeds Only; 73%, na, 62%*; 17%*, 1%, 0%,

16%, 57

Prostatectomy; na, 79%, 79%; 21%, 8%, 0%,

33%, 62

Proton Beam; 73%, na, 62%*; 38%*, 1%, 1%, 25%, 65

HDR>EBRT ; 79%, na, 68%*; 32%*, 5%, 1%,

39%, 77

External Beam; 53%, na, 45%*; 55%*, 1%, 0%,

35%, 91

Cryotherapy; 69%, na, 59%*; 41%*, 5%, 0%,

75%, 121

Shaded Italics = Estimated

*Calculated DF and TF (0.2 ng/ml)

ASTRO/1.17 rate

**Adjusted One Year ED Rates

Carl

dtc wrote:

All other treatments appear to have moderate to severe side

effects.

Nanoknife claims not to. The doctors should know by now what the short

term side effects are.

Seems to me the most difficult part of this is getting the proper

electrode placement.

All the treatments are a crap shoot. At least Nanoknife appears to have

minimal short term side effects, no radiation, and no major surgery.

Doug

[Guest guest]

There are three things about IRE-Nanoknife

that I think are of particular interest or should be considered:

1. Why is it termed Nanoknife? I first

came across the term some years back – see this article for example http://tinyurl.com/39qd7s

which referred to the so-called nano-technology which allowed

unbelievably small particles to be absorbed by cells which were then treated –

in this case by light. The IRE-Nanoknife does not seem to include any

nanotechnology from what I have read on the subject. So is the name part of a

marketing campaign to imply this is a new technology and therefore part of the

inevitable march to improvement – like cell phones and new computer

software, but unlike Betamax video or eight track music tapes?

2. There is a lack of independent

studies on the subject of collateral damage. It may be that this form of

treatment does indeed become the one and only therapy that does not cause

damage to other parts of the body, but since it destroys all cells in between

the two nodes, it is difficult to see how this will occur. Much would surely

depend on just where the tumour being treated is situated. In references to the

number of IRE-Nanoknife procedures that have been carried out it is common to lump

all such procedures into the mix – I believe from all I have read that

the number of prostate cancer treatments has been very small to date. Having followed

the development and marketing of other new therapies, such as HIFU and Focal

Cryotherapy one of the aspects I have noticed is the claims made earlier on for

success rarely mention any side effects. It is only later that these are

acknowledged. So, with HIFU for example, when the initial studies were

eventually published, they referred to some of the side effects – like the

development of fistulas, for example, that had been a feature of the early

treatments, which had no been overcome by better focusing of the equipment. But

these fistulas were not even mentioned initially.

3. The third point concerns the focusing of

the IRE-Nanoknife equipment. For many years we have been told that due to the heterogeneous

nature of prostate cancer the cancerous cells are spread throughout the gland. This

is why, so it is said, biopsy procedures are so unreliable – they may

miss more cancer cells than they hit. But the essence of IRE-Nanoknife

procedures, as is the case with other focal procedures is that the cells must

be identified very clearly for the therapy to work. How can this be done with

current equipment? The current answer is saturation biopsy procedures where the

gland is assailed by 50, 60 or more needles in a grid. But even then some

cancer cells may be missed both because needles are straight and prostate

glands are not and because the ‘mesh’ of needles cannot be fine

enough. Steve Z who chose focal therapy and who tells the story of its failure

at http://www.yananow.org/Mentors/SteveZ.htm

and says in part:

<snip> My biopsy results were not what I'd hoped for: 12

needles found two small (10 and 15%) areas of Gleason 6 cancer again on the

right side that either the cold didn't kill or the focal treatment missed. The

latter is likely the case: if you do the math on the biopsy data, the areas of

cancer were 2mm maybe 3mm at the most, the grid for the mapping biopsy was 5mm;

if you move the grid a mm or so you’ll find different small cancers. <snip>

I too admire pioneers. Without them there

would be no advancement. But I do believe they should be told clearly the

unadorned truth about potential risks and shortfalls of any new therapy.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of dtc

Sent: Monday, 28 February 2011

4:53 AM

To: ProstateCancerSupport

Subject:

Re: Nano Nano Nano

All other

treatments appear to have moderate to severe side effects.

Nanoknife claims not to. The doctors should know by now what the short

term side effects are.

Seems to me the most difficult part of this is getting the proper

electrode placement.

All the treatments are a crap shoot. At least Nanoknife appears to have

minimal short term side effects, no radiation, and no major surgery.

Doug