I am now 3 months after Nanoknife treatment and thought I would share my experience with others here. Sorry it's a bit long, but hopefully some will find it interesting/useful.
At treatment: Age 55, PSA 7.6, rising at a rate of 0.8/year, diagnosed as Gleason 6, tumour localised on the right side, anterior region.
I was offered a range of possible options (surgery, radiotherapy, active surveillance) by my local hospital in Yorkshire, including the opportunity to go and be considered for focal therapy in London. After a period of active surveillance at London's recommendation, MRI returned evidence that the tumour had grown slightly over a two year period (to ca. 12 mm), and the continued rise in PSA combined with the relatively large size of the tumour meant the team recommended focal therapy. The fact the tumour was anterior, and difficult to reach, meant Nanoknife was the recommended strategy.
To be eligible for Nanoknife, you should have intermediate grade (Gleason 7) prostate cancer, or a large Gleason 6 tumour. It must be confined to the prostate, on just one side, and should ideally be <15mm in size. PSA should be <15 ng/mL.
Having Nanoknife is rather like having a transperineal biopsy, in that they insert long metal 'skewers' through the perineum into a targeted zone of the prostate. The difference is, that with 4 of these inserted, they then pass an electrical current to destroy cell membranes in the zone between the electrodes. This kills off soft tissue, like prostate and cancer cells, but leaves structural tissue like urethra, prostate wall etc intact.
The primary advantages are lower side effects than other treatment methods, <5% long term incontinence, ca. 10-20% impotence problems. In principle, it kills all the tumour cells, although you have to be up for ongoing monitoring, and it is possible that a second Nanoknife treatment may be needed. Nanoknife leaves all other treatment options on the table. About 75-80% of men do not progress to need further radical treatment within 5 years. Longer term data is less well established.As a potential advantage, because the cancer cells are ruptured, the antigens released can prompt the immune system against the cancer, but although this effect has been measured, it has not yet been established as being clinically beneficial.
The procedure is done under general anaesthetic and takes about 1 hour. It's done as a day case, and you are sent home with a catheter. My procedure was done on the NHS, who approved this technique for use in defined cases in 2022.
My procedure went well, although recovery was a little bit more rocky than in most cases. Because the tumour had been large and close to the urethra, there was quite a lot of prostate swelling in that area. I failed the 'test without catheter' at 6 days, being unale to pass any urine. I therefore had to catheterise for an additional 2 weeks before all the swelling went down (I was able to do this by self-catheterisation, which is more convenient and less painful than the in-dwelling catheter). At the time this was very psychologically stressful, but looking back and knowing how it all turned out, it wasn't so bad.
I was happy that the MRI at 7 days showed the tumour had been appropriately targeted by the Nanoknife with good margins.
Most pleasingly, my 3 month PSA test was down to 0.85 (a 90% decrease from before). This is a great result - typical reductions after nanoknife are 60-70%. Obviously I stil have three quarters of a prostate, so unlike people who have surgery, there is still a PSA value. PSA now has to be monitored every 3 months (switching to every 6 months after a year). I will also have MRI scans at 1 year, 3 years, 5 years. Hopefully, my PSA remains stable and MRI remains clear, there is no need for further action for some time to come.
In terms of side effects. I still have some urinary urgency - when I need to go, it feels urgent, but I am better able to manage this as time goes by. I don't have any incontinence, and I am going a normal number of times a day (6-8). Although I did not officially have urinary retention or other problems prior to the procedure, I would say my urine flow now is significantly stronger than before.
Sexually, erections are good, but I now have retrograde (dry) orgasms. They feel fine, but nothing comes out. I do still get pre-cum though. Dry orgasms happen in about 20% of cases after Nanoknife, and it's a shame, but given the great PSA result, for now I am happy.
Obviously there is no 'cure' with any prostate cancer treatment, and Nanoknife needs more follow-up than some other methods, but given my age and the fact I'm very active at work and in life, I am, at least for now, pleased with my choice.
Hopefully focal therapy like Nanoknife will offer men with lower grade early stage disease a halfway house, where they do not have to jump to more radical surgeries with high side effect profiles. As such, Nanoknife may change the risk balance about screening for prostate cancer, because the risk of overtreatment is lessened. Screening for all would mean that more men would get diagnosed earlier. Ultimately, early diagnosis is really worthwhile if there are simple, effective, low-side-effect ways of intervening that can treat the disease. This is my hope for the future of prostate cancer treatment.
