Determination of the tumor stage: Staging and Grading
When the diagnosis of prostate cancer has been established, the next step is the determination of the tumor stage through:
1. The process of staging, which can be done pain-free and precise with help of Biopsy-Free-Diagnostic and MRI Whole Body.
The staging process determines whether the tumor is confined to the prostate or whether it has spread beyond the confines of the prostate capsule and whether the tumor has spread to lymphnodes, other organs or bones.
2. Grading (determination of the spread of the tumor and its aggressiveness), which will be done most precise with 3D-Biopsy. For tumor grading, tissue samples from the prostate have to be analysed histologically.
The overview of the current routine Prostate Cancer Treatment Methods
Which treatment is chosen for which patient depends on many factors: Besides the tumor stage and grade the choice is also influenced by the patient’s age and health, but also by personal preferences.
When the carcinoma is confined to the prostate, a focal treatment method which focuses on the prostate can be chosen.
The current routine focal treatment method is the surgical removal of the prostate (radical prostatectomy), also with robotically-assisted surgery (so-called Da Vinci Surgery).
Other treatment methods comprise brachytherapy (internal radiation treatment through implanted radioactive seeds) or an ablation of the prostate with focused ultrasound (HIFU) or through freezing (cryotherapy).
All these methods, however, have severe side effects and result in erectile impotence in the majority of patients and cause urinary incontinence in up to 50 %.
When the cancer has spread beyond the capsule, hormone therapy (blockade of male sexual hormones) or external radiation therapy constitute the primary choices for treatment. Such treatments have also adverse side effects.
Paradigm Change in Prostate Cancer Treatment: Function-Preserving Therapy without Impotence and Incontinence – NanoKnife
The prostate is surrounded be anatomical structures which are responsible for the erection of the penis and the control of the voiding of the urinary bladder. Preservation of these structures is necessary for an unimpaired sexual- and bladder function.
With currently established treatment methods this is not possible because during therapy not only the prostatic tissue, but also the surrounding structures are damaged.
NanoKnife: New Promising Prostate Cancer Treatment with Irreversible Electroporation (IRE)
Nanoknife is a novel promising method for the selective destruction of tumor cells by strong local electric fields. Affected by the electric fields of several thousand volts cell membranes are opened up until the cell ruptures. This process corresponds to an induced apoptosis (natural cell death).
Non-cellular tissue components are not damaged by the NanoKnife-Treatment.
The tissue matrix, which is made up of collagen and elastin fibres, proteoglycans, etc., remains fully preserved. Because blood and lymphatic vessels as well as the urethra, besides cells, have an extensive and stable tissue matrix, they regenerate fully: The destroyed cells re-colonise along the matrix.
Other treatment methods, which destroy all tissue elements, induce a tissue necrosis (coagulation of all tissue components). This necrosis is eventually removed over the course of many months by an inflammatory process encompassing the necrosis. This process causes inflammatory pain and, after healing of the necrosis, scarring, which can severely hamper subsequent treatments.
NanoKnife or Irreversible Electroporation, on the contrary, does not induce any tissue necrosis and consequently no inflammation. Treatment with the NanoKnife thus avoids pain and scarring. Because blood vessels and tissue perfusion are preserved the dead cell’s debris is removed quickly from the treatment zone.
Consequently, healing is usually completed within 14 days after treatment.
Specific Indications for Treatment with the NanoKnife
Besides usual case of the prostate cancer the Nanoknife, can be used also in following cases:
1. Prostate Cancer Recurrence: After Prostatectomy, Radiation Therapy and/or HIFU
An important application the NanoKnife for is the treatment of recurrent prostate cancer after surgical prostatectomy and/or radiation therapy or after treatment with HIFU (High-Energy Focussed Ultrasound). There recurrences can be treated selectively with the NanoKnife without significant side effects.
MRI scans of the prostate before (left) and after (right) IRE (NanoKnife) treatment of a recurrent prostate cancer after previous treatment with HIFU. Upper row shows T2-weighted, lower row images from a dynamic contrast agent series. Before IRE-treatment the recurrence is evident by its pronounced contrast agent uptake (yellow arrow below). One day after IRE-treatment the strong contrast agent uptake is no longer evident (red arrow below).
2. Prostate Cancer Extending Beyond the Prostate Capsule
Treatment with the NanoKnife is also possible when a prostate cancer has spread beyond the capsule of the prostate. Infiltration of the seminal vesicles and of the pelvic floor can be included in the treatment field. Results from animal experiments indicate treatment of cancer infiltrating the rectum might be possible, too.
Which Method for Which Patient?
Outline of the 3D-Biopsy-Work-Up and Nanoknife-Treatment
Step 1: Preparation for the Treatment -3D-Biopsy-Work-Up
1 Day: Localisation of the tumor cells with 3D-Biopsy-Work-Up
2 Day: Histological investigation and MRI-Control
Step 2: Nanoknife Treatment
3 Day: Prostate Cancer Nanoknife Treatment
4 Day: MRI-Control and Discharge from the hospital
The Costs of the NanoKnife Treatment
The costs for NanoKnife-Treatment are 19519 Euro.
The treatment costs include:
- Consultation with the doctors
- Nanoknife Treatment
- One night hospital stay
- MRI-Control of the pelvis next day
The Costs of the 3D-Biopsy-Work-Up and Nanoknife Treatment
The costs are 29900 Euro.