nano nano-mork and mindy, prostate cancer and new treatments- insider tip: when it comes to new procedures, in general you don’t want to be “the first one.”


The Nanoknife procedure

PDF’s about the machine and company

Nanoknife on dogs….hmmmmmmmmmmmmmmmmm

The following article is from my home town here in Georgia. I bet fifty patients asked me about the procedure over the last few weeks. It was also in an article in the Atlanta Constitution. I had a doctor ask me about it and confessed I had never heard of it. I did know however that there would be no cutting involved. It seems that all the non surgical treatments these days have a catchy name to make it seem like or appear that there is cutting involved. I feel this is in response to the popularity of the robotic prostatectomy and maybe the appearance of surgery comes across more aggressive. In this case nanoknife sounds better than treating a prostate with electricity.

When you read about new treatments and prostate cancer remember this. There is the short-term i.e. getting through the procedure safely. Then there is the long-term i.e. curing the cancer, and avoiding the side effects as they pertain to how you void and sexual function. In the article you see comments about , had the procedure at 7 and home by 2….well that is good. There real story will be at six months and how one does with the trending down of the PSA (i.e. the cancer has been treated) and how things are going with voiding and sex.

As my mother would say, to each his own. My hope that Mr. Taylor does well. All of the energy based treatments will have a role going forward. And each will have a more significant role in the patient that wants to be treated, may have a mild medical issue, and is in his early seventies.

Nothing hurts short-term good results more than long-term follow-up. We will await five-year follow-up on hundreds of patients to see if this new procedure will have a role in prostate cancer. PS…I will look into the process of a urologist getting trained for this as any urologist must have many arrows in his quiver in what he can offer patients that have different medical conditions and wishes regarding how they want to treat their cancer.

Local man undergoes new procedure to treat prostate cancer

Brandee A. Thomas
bthomas@gainesvilletimes.com
July 9, 2010

Bob Taylor knows how draining radiation can be on the body.

Each week, he drives patients down to the Veterans Administration clinic in Decatur for radiation therapy.

“It’s usually eight weeks worth of therapy, five days a week. By week five, they are usually pretty dragged out — it really takes a toll on your body,” said Taylor, a 72-year-old Gainesville resident.

So when he was diagnosed with prostate cancer late last year, he knew radiation wasn’t a treatment option he wanted to consider.

“I went to a local urologist, he took 12 biopsies and two came back cancerous. The first thing he did was recommend that I get a second opinion, then he presented the treatment options,” Taylor said.

Those treatment options — prostate removal, radiation or exposing the cancerous cells to extreme temperatures — weren’t what he wanted to consider.

With the help of his wife, Taylor set out to find a more viable alternative. After finding the name of the Atlanta-based Malizia Clinic online, Taylor called to make an appointment for a second opinion. That call ultimately lead to Taylor earning a first-place spot in medical history.

During his consultation at the clinic, Dr. Jaime Wong told Taylor there was an additional treatment option he may be interested in: the NanoKnife IRE System. That option is less invasive than the others, has a shorter recovery period and fewer potential complications.

“I was in the (Atlanta) operating room by around (7:45 a.m.) and was back home by 2 that afternoon,” Taylor said.

“There was no pain and no pain medication.”

The system has been used in around 250 cases worldwide, but Taylor’s surgery was the first time that the procedure has ever been performed on the entire prostate or by a urologist.

The NanoKnife IRE (irreversible electroporation) System uses electricity to kill cancerous cells.

“The (NanoKnife) probes create an electric field that create little defects in the surface of (cancer) cells,” Wong said. “These cells need a solid membrane to live, so this causes them to die.”

Unlike with treatment options like cryoablation , freezing the cancerous portions of the prostate, or radiofrequency ablation — exposing the cancerous cells to extreme heat — the NanoKnife doesn’t cause damage to surrounding tissue, nerves and blood vessels. Thus, it eliminates possible side effects like impotence or incontinence, Wong says.

Because the technology is relatively new, medical professionals are still trying to determine who the best candidates are for the NanoKnife procedure and what its side effects.

“We’re trying to look for better treatment options for this very common disease — it’s the most solid organ cancer in men in the United States,” Wong said.

“More than 200,000 men are diagnosed every year in the U.S., just over 30,000 men die every year from it. There are a lot more men being diagnosed than are dying, so that means we are doing a good job of treating it, but we could always do a better job.”

Since having the surgery three weeks ago, Taylor says he hasn’t had any major problems, especially nothing on par with what others who’ve had more invasive surgery have experienced.

“Several friends have had (other surgical) procedures to treat prostate cancer, so I had something to compare it to. Usually you’re out of service for at least a couple of weeks, but not me,” Taylor said.

Although he’s serving as a guinea pig of sorts, Taylor has taken a “someone has to be first” attitude about it.

“I was a test pilot for a living, so I’m used to doing things that others may not want to,” he said.

“After weighing all of the side effects and other treatment options, I would do it again in a heartbeat.”

http://www.gainesvilletimes.com/archives/35215/

Share

42 Replies to “nano nano-mork and mindy, prostate cancer and new treatments- insider tip: when it comes to new procedures, in general you don’t want to be “the first one.””

  1. Dr. McHugh,
    As a fellow doctor (retired OBG) undergoing “the decision”, I found this article quite intriquing. I am currently scheduled for a robotic prostatectomy in three weeks. I have one out of 18 cores with some Gleason 3+4. I am a young 57 and care very much about continence and sexual function. I had read about IRE being done in dog prostate studies, and to find out it had already been done in humans was news.

    One minor correction to the cited article. I don’t think it selectively kills just the cancer cells. But it is supposed to preserve the connective tissues and blood vessels and nerves. I don’t know how they monitor damage, but I have read the damage can be seen on ultrasound. If you find any long term (I guess 2 years will be about all the data unfortunately) studies, please post them.

    Thanks for all the great help you do for us while making the decision,
    Russ Hustead

    Like

  2. What are the alternative treatments for Mr Taylor if his PSA starts rising? Has the nanoknife left some of the remaining tissue friable so that other forms of prostatetectomies are no longer an option? Is the nanoknife able to handle large volume and high Gleason score prostates? What are the inclusion criteria for nanoknife surgery?

    Like

  3. I’ve been researching IRE all morning. My impression is that the damage is quite localized and that a salvage prostatectomy would be possible, but I am just guessing. A repeat IRE was mentioned as a possibility. The limited studies I read only treated Gleason 6 and lower. And only went out one month. One of the five patients had an increase in PSA at 30 days. Here is the link:

    http://files.shareholder.com/downloads/ABEA-3PILLM/0x0x326396/659c162f-80c1-41ff-bda0-942cc8273028/IRE_symposium_presentations.pdf

    If anyone can find other clinical studies, please post.

    Like

  4. I had nanoKnife prostate procedure on 7 June at U. of Miami Sylvester Comprehensive Cancer Clinic by a radiologist, Dr.Narayanan. Stayed overnight as a precaution because I was their first prostate procedure (UM team has used it on other organs for a while). Catheter removed in AM and released. No problems from that moment. PSA was over 6 prior, and 30 days out PSA is 2.5.

    Kind of irrevelant whether I or Mr. Taylor were “first in USA” main thing is I wish him well and highly recommend other prostate cancer patients to research this procedure. I too wished to avoid the problems associated with more “traditional” treatments.

    Thank God for the internet. Found out about it with own on line research. No Docs here (east central Florida) told me about IRE (irreversible electroporation) but my second urologist at least had an open mind about it when i brought it up.

    It’s my understanding that the NanoKnife needles target specific cancer cells, leaving the surrounding tissue intact and functioning, and that the targeted area will have no scarring.

    You can set up an automatic keyword search for “NanoKnife” or “electroporation” on Google that will send info almost daily.

    Like

    1. Thanks for your comments.
      I have found very little information about the application of IRE for the prostate. Do you know the answers to the following questions from your experience and research?
      What is considered the nadir of ” cure ” of the PSA after IRE?
      How long does it take the PSA to get there i.e. your PSA I assume will decrease even more to negligible levels in time?
      Can you repeat the procedure?
      Is a radical prostatectomy more difficult after IRE if the PSA doesn’t reach a nadir.
      Is it still in clinical trials? Is it FDA approved yet for common use? If not when? How many procedures had your docor done?
      Are radiologists the doctors that do this? Was a urologist involved at all in the treatment?
      What is the longest follow up data after IRE on PSA levels, continence and sexual function?

      As a urologist who has done hundreds of prostatectomies and now maybe too far along in my practice to learn robotics, I am excited and not threatened by the new minimally invasive procedures. I am planning to take a course on HIFU in the near future. I look forward to your response and it may be of help to some of our other readers such as Dr. Hustead. JM

      Like

    2. Hello Walter,

      My name is Andrew and I am from the U.K.
      I have recently became aware of Irreversible Electroporation and am considering it as a treatment for Pca.
      Having read your post to Dr. McHugh regarding your
      treatment with IRE , I was wondering if you could let
      me know how you are doing since June 2010 when you had the procedure done.

      Looking forward to hearing from you.

      Regards,
      Andrew

      Like

  5. Dr. McHugh- I think Dr. G. Narayanan at UM Miller School of Medicine, Sylvester Comprehensive Cancer Center would welcome contact from you. He is an Interventional Radiologist. You have the benefit of both speaking “Doctor language.”

    To my knowledge, the cancer has been eliminated. Obviously some follow up tests will be necessary, and UM has forwarded (with some delay) to my urologist in Daytona Beach. Will see him soon. Also believe the 2.5 falls within “normal” ranges- Dr. Narayanan pleased with that as is my GP. Also believe if further treatment is necessary, NanoKnife or any other treatment options can be utilized. There are some treatments as I recall, that if done prior, might PRECLUDE NanoKnife. (Will refer to it as IRE to cut down on typing!) Procedure is FDA approved. Insurance paid for it. (You know, those evil blood sucking insurance companies!) My understanding of the Georgia IRE was by a urologist, so i guess that’s 1 urologist and 1 radiology for prostates in US. Just a guess, I think eventually it will be mostly urologists.

    Sexual function and incontinence not a problem at all. Took me a while to urinate on my own after catheter removed, which I had to do before they let me out, but a helpful nurse told me to think about Niagra Falls. All systems working as before. Some blood in semen, but had that after saturation biopsy also.

    Dr. Narayanan consulted with numerous professionals, including Italian MDs who have used this for a while, Dr. Gary Onik who along with Boris Rubinsky (engineer) worked on the development of IRE. Onik also had a hand in development of focal cryobation and 3-D mapping biopsy of prostate.

    Nayayanan brought in team from Angio Dynamics (NanoKnife manufacturer) and from a company with a new multi dimensional ultra sound equipment.

    I realize I was a quasi experiment, and time will tell, but Dr. Narayanan did a lot of prostate specific research and assembled an impressive team for the procedure. He is also a nice man, so again, I suggest you make contact with him.

    Like

  6. Andrew- Appears jury is still out on me. PSA was over 6 day of procedure in June 2010, 2.5 shortly after. 3.5 2 months later, and 3.7 3 months after that. The IRE procedure was done at U. of Miami, my Urologist is in Daytona Beach. The Urologist sees no reason for panic at this point, will have another PSA in a month (3 month follow up). He thinks the first PSA was too soon after the procedure to be meaningful. Also does not think another satruration biopsy necessary at this time. Guess we’ll see where we go after the next PSA.

    Sexual function remains fine, and absolutely no incontinence problems. Other than still being in limbo about a “cure” the only problem I have encountered is with the IRE team being in Miami and Urologist and me being 6 hours away. The lines of communication between professionals could be better. Dr. Narayanan (the Radiologist who performed the procedure on me) in Miami has consulted with a UM Urologist, and will contact a Dr. Wong in Atlanta, a Urologist who has now done several IRE prostate treatments. I can’t say enough positive things about Dr. Narayanan. He is very accessible and responds to phone calls and e-mails promptly.

    I remain optimistic and still believe in the NanoKnife procedure. If it turns out first treatment missed some cancer I would most likely have it done again (but would do further research). The experience I had of a brief hospital stay, no pain and no problems with bodily functions as compared to the “standard” treatment options would lead me to a repeat treatment if necessary. Again, though, with further research. The above quality of life items would certainly be outweighed by potentially losing life. I wish you well Andrew and hope this helped.

    Like

    1. Hi Walter,
      Hope you are well.
      Just checking to see how you are doing since your IRE procedure
      a year ago last June.
      Regards,
      Andrew

      Like

    2. Walter – I hope you are well and would be very interested to hear what time has shown so far. I am considering the same procedure at UM. The nano-knife sounds very promising and it would great if it kills the cancer without the side traditional effects. Thank you.

      Like

      1. Mark,

        Who at UM is doing prostate Nano? I thought they had stopped doing it for prostate.

        Have they shared any results with you?

        Thanks,

        Doug

        Like

  7. Hello Walter,
    Good of you to reply, thank you.
    I did speak to Dr. Narayanan , and yes he is a very helpful and friendly person. I didn’t know that you were his first and only (so far) patient for prostate IRE.
    He seems to be quite positive about the procedure.

    He is going to give me the contact details of a hospital in Italy that is also doing IRE , and which might
    be a little easier for me ( though I wouldn’t mind a trip to Miami or Atlanta !! )

    I hope he is right that your initial PSA was taken a little too early, and that you should see a downward trend from now on (my fingers crossed for you)
    I will let you know how my reserach goes.

    Be well and take care.
    Thanks again and Best Regards, Andrew

    Like

  8. Nano Nano Nano

    As a newly diagnosed prostate cancer patient with what appears to be small, slow-growing tumor*, I’ve read Dr. McHugh’s book and a half dozen others on prostate cancer. 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?

    Thanks,

    –Milt

    *Diagnosed 1/31/2011 at age 70, 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.

    Like

  9. Very interesting info on IRE! How does this compare with HiFU or other non surgical treatments?

    What Drs in New York State are doing IRE?

    Thank You.

    Like

  10. Hi. My husband was recently diagnosed with pancreatic cancer. The tumor has completely encased the portal vein and 270 degrees on superior mesenteric artery. Dr. Strasberg of Barnes Jewish Hosptial says the cancer is inoperable. I don’t take “no” for an answer very well so I was researching and found the Nanoknife procedure. I contacted Dr. Robert Martin at Louisville, KY. After several cycles of chemo, my husband is going to the University of Louisville for treatment. The nanoknife will be used in an open surgery and my husband will be in the hosptal for 7 to 10 days. We had a DNA test run and it showed my husband has two abnormal genes that will make chemo too toxic unless the dosage is monitored.

    Like

  11. All- Appears on me the NanoKnife at U Miami in June 2010 was only partially succesful, if that. PSA now up to 6.1 again. Dr. Narayanan (radiologist) conferred with Dr. jaime Wong from Atlanta, a urologist who has now done 21 procedures on prostates. Both agreed I should have a biopsy. My original urologist here in Daytona thought that was a waste of time, so I went to another who agreed. Both recommend Eligard hormone therapy and IGRT. Both also seem to think NanoKnife is some kind of voodoo medicine, In view of the prestigious cancer treatment hospitals who are using it, I don’t have a lot of faith in the voodoo conclusion. I recently spoke with Dr. Wong and he has had apparent success with 20 of his 21, and still using the procedure. He again suggested a biopsy, which I will do. If nothing else I’ll feel better knowing the more destructive IGRT is absolutely necessary. And, I am not ruling out further NanoKnife for all the same reasons I was willing to try in the first place. I think one problem is the location of the prostate in the body, and inexact imaging during the procedure to place the needles precisely where needed. I want to make clear my respect for Dr. Narayanan in Miami. He has been with me all the way, answers e-mails and phone calls and is a genuinely nice man and caring physician. Walter

    Like

  12. Have each of those undergoing Nanoknife Prostate Surgery paid for the procedure “out of pocket?” If so, how much does iy cost? A few other alternative procedures are asking a MINIMUM of $25,000 (not including air fare, hotel, etc.)
    If other procedures van be used later, I’m wondering why Nanojbife isn’t a resaonable procedure for a guy 77 who is not anxious to endure the side effects of other tarditional procedurse. It’s very easy for a Urologist to recommend a process they themselves don’t need.

    Like

  13. My procedure was paid in full by our medical insurance. (Group plan from employer). However, i would advise all to check with the the physician/hospital first to be sure, and get it in writing. Walter

    Like

  14. In march 2010 my Dr. suggested a biopsy.PSA went from 3.9 to 4.3 in 3 months.
    In April my uroligest took 16 cores 4 were bad. Gleason score 3×3= 6
    Started my own research in April.
    In June I had a complete mapping of the prostate. OUCH!!
    36 cores 6 were bad, one on each side of my colon. Gleason was now 3×4=7
    More research lead me to IRE.
    In July of 2010 I found 2 Dr.s in the U.S. that did the procedure on the prostate, one in Florida and one in Atlanta.
    I spoke with Bob Taylor then Dr. Wong.
    Had my IRE Oct. 4, 2010.
    My 18th month PSA was 0.7 will be getting my next PSA in July which will be
    22 months after my IRE.
    I was Dr. Wongs 7th patient, he has done over 30 patients now the majority of those done in the U.S.

    Any questions, andycaldarella@yahoo.com

    Like

      1. Andy,
        I am from the UK and am interested in the IRE approach. Funnily enough my Consultant Urologist has started doing IRE ( about 7 or 8
        procedures so far ) and he seems to be quite enthusiastic about it.
        He has been mainly doing HIFU for the last 8 years. I ‘m not to keen on going down that route.
        Would like to know how your PSA results went in July. Hope they are in the right direction , and if you had any side-effects from the procedure.
        Best , Andrew

        Like

      2. Sorry , it took so long to reply.
        I was on vaction and my Dr. was also.
        At 22 months my PSA droped from 0.7 to 0.5 that is the lowest it has been.
        The thing about the IRE is if it fails you can still do any other proceedure, even a second IRE, but if you do anything else first you can not do the IRE.
        Every man has to make their own decision, I chose the IRE my brother-in-law had his prostate removed. Good luck.
        Andy

        Like

      3. Not a lot of pain, didn’t take any pain killers.
        Went shopping with my wife the next day.
        Wore cathiter bag for 3 days.
        Had to self cathiter for two weeks. (fun !? )
        Swelling, enough for the whole package to go below water level when I sat on the toilet, my anal sphincter was flush with my butt cheeks. Not alot of pain just swelling. Used a ton of ice.
        SEX…..If you get an IRE , get a penis pump and some viagra , do not use till Dr. gives approval.
        The mental preasure that men put on themselfs is the worst side affect.
        If it worked before the proceedure it will work again !
        It takes time, be patient and don’t beat yourself up over it, thats what I did.
        It can take 1 to 2 YEARS ! I had no radiation and no surgery and I have a cancer free protate and “IT” works, what more could you want ?
        Andy

        Like

      4. Had gradual increase in PSA until it reached 15.5. I’m 78 now. Was rejected by two sites for Nanoknife and told too old for radical procedure. Chose Cyberknife in Boston. Felt fine for two days then floored. Needed catheter for three weeks. Side effects began to ease. Still have biruning sesnsation at both ends and weekly loose bowel movements, However, PSA dropped to 3.8 in three weeks, to 1.14 in four months, and ,8 two weeks ago. After a dgital exam
        last week, my regular Urologist (performs radical) said the Prostate was “soft” and said I did not need to see him for a year. He gave me medication for the pebis burning.
        The burning issue worries me, but was toold by Internist that the penis problem could be from Catheter or scar tissue. He appears more concerned the rectum burning.

        Like

      5. Doug,
        Yes.

        When anyone developes cancer anywhere in their body it is a life changing experience. The first choice is accepting the fact and getting a second opinion, or just ignore it.
        The next choice is to continue to just ignore it , or get treatment.
        Getting treatment is not easy, depending on your age and health and at what stage you are at.with your cancer.
        With any treatment you will have to jump through more hoops, EKG.MRI, Cat-scan, and then be told your not able to have a proceedure.
        Today there are several options besides radiation and removal, both I rejected.
        There is lazer (burning), cryo (freezing) proton ( pin point radiation) branch therapy ( radiation seeds) and IRE. There is a study in Glassco that involves the patients own DNA, which is still involved with testing.

        The option for any radiation was out for me.
        Lazer and cryo cause too much colateral damage to the surrounding area of treatment( ( kills tissue around treated area) so I passed on those.
        The IRE does not kill or damage any tissue or blood vessels.
        IRE is an electric pulse that burns a hole in the cancer so oxygen can enter the cancer cell and then dies. IRE is not heat it is electricty.
        With me, I had a complete mapping of my of my prostate, which is samples from my whole prostate surface.
        So Dr. Wong knew where every cancer cell was in my whole prostate.
        With IRE the Dr. uses a minimum of 2 probes and up to 6 probes at a time.
        In my case Dr. Wong used 6 probes twice for a total of 12.
        I assume it was 6 for each side of my prostate.
        My pain was probably from a biopsy in April a mapping in June and the IRE in Oct. After 7 months of pocking , pinching and electricution my prostate had enough. It is no picnic.Woud I do it again ? Yes! My advise, get a mapping
        before you do any treatment. Don’t do a half ass job, get all the facts and information. I believe my mapping made my IRE a success.

        Like

      6. Doug, no side affects 22 months after my IRE.
        E.D. is a common side effect for most treatments.
        Recovery time varys 6 mo, 1 year 1 1/2 years 2 years.
        If you get an erection before an IRE you should get one sometime down the road after.
        Everyone is different.
        Any treatment you get also get a penis pump and viagra, and DON’T USE THEM TILL YOUR DR. GIVES THE OK.
        Get the blood flowing again.

        Like

  15. Would like to know the MD who performed IRE on Andy. First, I am very happy for your cure. After initial positive signs (lower PSA) mine has climbed ever since IRE in June 2010 at U Miami. I have been dragging my heels because of little confidence in the urologists in Daytona area, who wanted to do chemical castration and radiation based solely on rising PSA- no further imagery or biopsy. Went back to the first urologist who agreed to a multi parametric MRI at Shands Jacksonville, and a 12 core biopsy. Results of both indicate I am about where I was in 2010. Still confined to right lobe, no spread. Will probably have IMRT Novalis TX with marker seeds planted next week. Not really happy with this, but it has been a 3 year drag on us and I suppose there is a mind set of get it over with and hope for the best consequences. An old friend who is a nurse just made contact with her friend who is an oncologist in JAX who uses tomotherapy. Waiting a return call from that doc. I would consider IRE again, and was in contact with Dr. Wong in Atlanta months ago, but at that point he had no real results of year or more to report.

    I understand the logic behind “the first one” heading, but I have no regrets. someone was the first to try penicillin, etc. and i really think NanoKnife will prove to be a success. The problem in prostates might be the clarity of imagery while procedure is performed.

    I had none of the post procedure problems Andy had. Catheter removed maybe 16 hours later, no pain, swelling, nothing at all except blood in semen for a few weeks. Then again, he is cured, I’m not, so I speculate there was more area treated on Andy than me.

    My main impression in this whole experience is doctors kind of have blinders on limited to whatever treatment options THEY use, and don’t really want to hear about or answer questions on other treatments. One even admitted to me the whole process is “revenue driven.” Own a piece of a radilology clinic? “That’s the BEST!” etc. They also seem offended by a mere patient asking about something the ‘professional” never heard of. Sorry to be bitter and blunt, but it’s my balls and bowels involved, not theirs. My only exception to this is Dr. Narayanan in Miami. Might not have worked on me, but he remains accessible and I give him and Dr. Wong credit for thinking “outside of the box” with the goal of preserving functioning organs and maintianing quality of life.

    Like

    1. Walter,
      Have you researched about Cyberknife – check out their forum.
      Also in Germany they are doing IMRT with protons.
      Regards,
      Andrew , UK

      Like

  16. I was treated by Dr. Jamie Wong
    Malizia Clinic
    Atlanta ,Georga

    Had my IRE Oct 4,2010.
    Cost 65,000.
    United health care payed 100%

    At that time there were only two Drs. that did IRE on the prostate in the U.S.
    Dr. Wong and Dr.Narayanan .

    IRE must be your first choice , because you can try other options after an IRE.
    Trying any other treatment first will elimiate IRE from your options.

    Like

  17. Andy , Walter ,
    Hope you are both well. It is some time since you posted.
    How are you both doing after your IRE procedures ?
    Regards,
    Andrew

    Like

    1. It has been over 3 yrs, since my IRE.
      My PSA has remained under 0.7.
      My regular Dr. knows I had an IRE , but still asks if I had my prostate removed.
      He has a hard time finding it.
      It will be 3 1/2 yrs. in March/ April my next PSA.

      Like

      1. I am very happy for Andy! Glad that nanoKnife worked for you. I have not fared so well. Maybe setting a record for prostate cancer “cures” that were not. Was told AM after NanoKnife all the cancer had been removed. Followup PSA was 2.5, previous was over 8, so looked forward to next PSA and a lower number. Wrong. It eventually was back over 8, so decided on radiation. 9 weeks, 5 days a week. Followup PSA was 1.0 so again informed I was “cured.” Not so fast, my friend. Next was again over 8. Cancer had metasticized to the bones. So now having hormone therapy, hope that keeps me around for awhile.

        VERY IMPORTANT TO ALL READING THIS POST…I had a bone scan prior to NanoKnife which indicated no spread beyond prostate. None was ordered prior to radiation treatment. Had it been done just prior or during treatment, the spread to bones might have been caugt early enough to target a specific bone area. So please, I advise all reading this to have a bone scan prior to whatever treatment(s) you decide on.

        And again, very happy for Andy and his family for his succesful treatment.

        Walter

        Like

  18. Walter,
    Sorry to hear things didn’t go to plan with your treatment.
    You are quite right to emphasise the importance of bone scans. The
    same thing happened to my Father. Doctors seem to be fixated with the
    PSA numbers and something simple as a bone-scan seems low on their
    priority list.
    Sincerely hope you stick around for a long time to come. Good Luck.

    Andy,
    Great news
    Pretty sure your treatment turned out sucessful because of the prostate
    mapping biopsy you had.
    Regards.

    Like

    1. I actually had the Nano-Knife in June 2010 and was pronounced “cured” the next morning. This was 3 years before FDA approve the procedure for trials on the prostate. Important to note that a bone scan was ordered PRIOR to the procedure, which showed the cancer was confined to the prostate. First PSA 30 days later was much lower, but it began to climb again. Having been “cured” once, in 2012 I had 45 days of IGRT. This time neither the radiologist or urologist ordered a bone, PET or MRI scan before or during the radiation therapy. 30 day follow up, PSA was less than 2 and I was again pronounced “cured.” Not so fast my friend. PSA started rising, finally had a bone scan, and my two “cures” have resulted in metastatic bone cancer. Have had androgen therapy since Oct. 2012 and PSA staying below 0.1. Have had numerous PET/CT scans, so if the prostate doesn’t kill me, the excess radiation might! My concern now is my oncologist is not very aggressive. I know there are concurrent treatments in use, but when I bring them up she tells me “that is the next step.” Also important to note- androgen therapy is in no way a cure- it is just buying time.

      My best advice to anyone with a rising PSA is get a SATURATION biopsy or multiparametric MRI (or both) . and before any treatment option have some kind of scan to determine if the cancer (if any) is confined to the prostate.

      I hope Andy is doing well, along with all others who follow this blog. My goal is to be around long enough to see my oldest granddaughter graduate from high school in 6 years, but that is not very likely. Walter I

      Like

  19. My husband is currently looking for a doctor that performs the
    Nano knife treatment on prostate cancer. He has been told it is contained
    in the prostate. A bone scan has been performed and is clear. He has a Gleason score of 7 (3+4) and psa of 28.8. He is 65 with no ED issues at all.
    He is hoping a doctor in Dallas at The Baylor College of Medicine Medical Center will accept him as a patient. Most doctors have told us the Nanoknife
    is used for liver and pancreas tumors only.
    Any information or experience will be appreciated. Thank you so much. We
    live in Austin, Texas but can travel as needed. Note: Unable to locate a Dr
    in Houston at MD Anderson to perform the nano knife for prostate also.

    Like

  20. I think it is awesome that doctors and professionals are finding more efficient ways to perform surgery. Especially for those who have cancer, I think that the nanoknife procedure would make such a big difference in comparison to the standard methods. My wife’s brother was just diagnosed with cancer and we are hoping that he qualifies! Thanks for the information!

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s