Prostate Cancer Treatments in 2026

NanoKnife Therapy for the Treatment of Prostate Cancer

Steen Rees

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NanoKnife Therapy for the treatment of prostate cancer

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Nanonyphe therapy or irreversible electroporation is a technology which is used to destroy tissue. It originally came into use in the liver, but over the last 13 years, myself and other colleagues throughout the world have introduced it into the prostate as a form of focal therapy. The aim being to minimize the side effects of treatment compared to surgery and radiotherapy, but still get rid of the cancerous area. A bit like lumpectomy and breast cancer. So what's been the story? Well, having learnt it in 2013, I've now done over 800 cases, and in those 800 cases, we've done about 30 international publications. And what we found is firstly, it's safe. Secondly, it can treat all parts of the prostate. Thirdly, the nature of the prostate or size of the prostate has no influence on the success. Fourthly, the quality of life is considerably better than surgery and radiotherapy. And finally, we found that 85% of people, even after a prolonged follow-up, have been able to avoid surgery and radiotherapy. So this makes it a very attractive alternative option. But it is important to understand that it's only suitable in certain patients. And those patients are people with what we call intermediate risk prostate cancer, Bliasin 7, and there are two types of seven, three plus four or four plus three. Or in the new vernacular, it's level two or level three cancer. It must also be relatively localized, and everything has to marry up. The biopsies, the MRI, and the PSMA PET scan all must marry up so that you can be suitable for focal therapy. At this stage, internationally, it's becoming much more accepted. In England, the National Institute of Clinical Excellence, or NICE, has approved it and it's free through the NHS. In America, because of the preserved pivotal trial, it's now accepted by the FDA for prostate ablation and it has level one clearance through the American Medical Association for use in prostate cancer ablation. In Australia, we're in deep negotiations with Medicare to get it approved as well. Of course, it's TGA approved. So, what are the advantages of this technology over other technologies such as high-intensity focused ultrasound or cryotherapy or laser therapy? The main advantage is one, it can be used in any part of the prostate. Two, it makes no difference what the nature of the tissue is. Three, we can even treat disease which is microscopically outside of the prostate. Four, we have level one evidence that if the cancer is there, we will reliably ablate it. So to translate, that means that we have a 97% chance of successfully getting rid of the cancer in the area that it is. However, what we also know is that 15% of patients over a 5 to 10 year follow-up will get a new cancer in another part of the prostate. And at that stage, all options are still open. We can have surgery, radiotherapy, or even redo the nanonite therapy. And we've published on all those, suggesting that the results are very satisfactory in all those situations. So nanonife therapy now is widely used throughout the world. In Australia, I've been privileged to train many units in Brisbane, in Melbourne, in Perth, recently in Tasmania and New Zealand, and I've also been involved in the education of many urologists through the United States. This has meant that this technology can be widely used and can improve the quality of life of patients in select patients. Now, what do I mean by select? Well, what I mean is that in 20% of patients who present with prostate cancer, they'd be suitable for nanonnife focal ablation. And why has it come into being? Well, the reason why is because our imaging's improved. MRI and PSMA PET scanning make it much more possible to be able to identify these areas very accurately and therefore select patients who are suitable for this minimally invasive treatment. I've been very privileged to be part of the journey of introduction of this. I've also been very privileged to be able to have treated almost 800 patients and do about 30 international publications on evidence-based information about this exciting new technology.