Nano Nano Nano

[Guest guest]

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 options

It'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.