Minimally Invasive Focal Therapy for Prostate Cancer

In this episode of BackTable Urology, Dr. Jose Silva discusses focal ablation for prostate cancer. He invites Dr. Amit Patel and Dr. Ranko Miocinovic to share their experiences with focal ablation using the Nanoknife System from AngioDynamics.

If prostate cancer is suspected due to an elevated PSA and a suspicious MRI scan, a prostate biopsy is necessary to confirm the diagnosis. Both doctors prefer to perform their biopsies through a transperitoneal approach in an office setting with local anesthesia or ProNox. If a positive biopsy for prostate cancer is obtained, additional imaging to stage the lesion and radiation oncology is helpful in prognosing and treating the cancer, respectively.

Focal ablation is a new minimally invasive surgical technique that allows destruction of the cancerous part of the prostate gland without having to destroy or remove the entire gland. Intermediate risk prostate tumors yield the best results with focal ablation, specifically in the context of preventing post-operative sexual and voiding dysfunction. Once the focal ablation sensors localize the tumor in the gland, a variety of ablation techniques can be utilized. Both Dr. Patel and Dr. Miocinovic use the NanoKnife System, an irreversible electroporation system that uses an electric current to break up cell membranes.

Proponents of the NanoKnife System believe that it causes less peripheral destruction because it preserves connective tissue and minimizes destruction of nerves. Evidence also suggests that focal ablation using the NanoKnife system lowers the rate of scar tissue formation thereby lowering the rate of erectile dysfunction, improves protection of the urethra, causes less swelling of the prostate, lowers the risk of post-operative retention, and requires shorter operating time. Finally, this method of ablation allows for consequent follow up surgeries if necessary.

Next, the doctors discuss NanoKnife procedural techniques, such as surgical approaches, and using ultrasound-guided probe placement. When using this type of ablation, it is important to monitor the wattage of the NanoKnife carefully in order to prevent the ablation from causing thermal destruction. Finally, both doctors discuss the future possibility of adding focal ablation procedures as a first line therapy to the AUA guidelines on treating prostate cancer.