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Regular Member

Date Joined Jan 2011
Total Posts : 112
   Posted 2/10/2011 11:02 AM (GMT -6)   
Hi Everyone,
My husband was recently diagnosed in Jan. We took your suggestions and got a 2nd pathology report from Johns Hopkins. Kind of strange though as they only sent 6 of 12 slides. The pathology report came back the same 3+3 Gleason. The 6 positive slides read the same with similiar volume %. For some reason they did not send the 6 negative slides
Now we are at the decision stage. My husband is researching Nanoknife . The Dr. has only done 14 in US and he is located in Atlanta . He spoke their office and he said that someone there claimed that it did not work like radiation and did not cause damage to surrounding tissues only to cancer cells.
They use electric current to damage surface of cancer cells causing the cells to die . Anyway, does anyone out there have any information more info on this procedure?
Also, I am really interested in hearing from those of you who have researched and/or chosen open or Robotic surgery. and sharing your outcomes
This would be an easier decision if we knew how aggressive this was. There are tests in use to determine this. I know ther are some in trials
50 years old
Psa 2.8 in 1/10
Psa 4.2 in 12/10
Psa 4.1 in 1/11
Positive biopsy 1/11 Both lobes 6 0f 12 positive Gleason 3+3
Neg. DRE

Veteran Member

Date Joined Feb 2010
Total Posts : 3771
   Posted 2/10/2011 11:12 AM (GMT -6)   
>>This would be an easier decision if we knew how aggressive this was<<
it sure would!  just remember that there's a 40% chance that the actual pathology is worse than what the biopsy shows -- e.g., he may be a gleason 7.
nevertheless it seems to me that either radiation or surgery would be a safe choice, and i would stick with conventional treatment if it were me..
good luck to you both!
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 2/10/2011 11:33 AM (GMT -6)   
Nanoknife is a non thermal ablation treatment. HIFU is ablative but uses heat and cryosurgery uses cold.
Since it is so new and there is virtually no data to back up the effectiveness, using it would be a major risk. Years ago HIFU was touted as being one of the greatest new treatmemts and has been pretty much a bust when compared to the conventional therapies.
Also any doctor that has done only 14 procedures should be suspect as to his learning curve.
There are many treatments that have proven long term effectiveness curing low risk cancer of your husbands kind. Surgery, Brachytherapy, external radiation and Cyberknife all have good track records; some have greater side affects than others, so do your research carefully. Just because a technology is new it doesn't make it great.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 2/10/2011 1:20 PM (GMT -6)   
Hi diamonds3,

There is no way today to tell if its slow growing or fast, would you look back when he turns 60 and say Gee it was slow growing after all now its slowly grown to a Gleason 7

There will always be a new surgical procedure available, it all depends on what is right for that patient. Also check with your Ins they may not cover something so new

14 surgeries is not enough of a track record in my book.

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 2/10/2011 1:56 PM (GMT -6)   
Having had robotic May 2010, and that having failed, and having now had some 30 something radiation sessions, the last one tomorrow at 7am eastern standard time, I will offer my perspective.

They tell me they thought it was contained in the prostate. Aftward, they acted suprised and said they were very suprised that it had not been contained.

They then tell me, with positive margins and a 4+3 pathology, that Adjuvant radiation was the way to go. They tell me that had they know it escaped the prostate, they would have gone straight to radiation instead of putting me through major surgery (that comes with it's own lifechanging issues).

GREAT I think, I had that surgery for nothing. But then, you realize that was the only way to get the full pathology telling what what type of cancer I had.. it was aggressive. I opted to forgoe immediate radiation (which I really didn't want to have).. but my psa went up a few months after surgery, so I knew with the positive margins, rising psa, and G7, I had to go to the next primary option, which I viewed as radiation. Other than being a little sore, a little quick to have to pee again, and tired here at my last doses, I got through it. But what price I paid, and did it really work.. those are answers only the future can provide.

Robotic surgery, I handled it well... i'd be surprised if your husband didn't also. All of it is a shock to your system.. but mostly, you wake up, sore, go home with a new catheter and bag to pee in, while you teach your new muscles helping you to do so.

I stepped up my exercise right after syrgery.. 2 weeks... started walking a mile, then 2.. Now i'm hooked and feel really good. And new studies actually came out this past week about how that exercise can effect chances of a reocurrance. For the better. I find the walking simply gives me an emotional boost - which most of us need after all we've been through.

But that is me. Everyone's different. I was 51 at surgery last May.


Best of luck to you, and my fellow members. Bob on Cape

Post Edited (BobCape) : 2/10/2011 1:00:01 PM (GMT-7)

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 2/10/2011 3:30 PM (GMT -6)   
Adding to Bob's comments: there are ways to know with some degree of probability that surgery will or will not provide a cure. MRIS or color doppler scans can indicate the location of the cancer. If it is the APEX or near the margin or near the seminal vessicles or nerves then there is a high probability that surgery will not result in a cure.
I think that many unsuccessful surgeries could be avoided in more patients received better staging through these commonly available scans.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Regular Member

Date Joined Jan 2011
Total Posts : 112
   Posted 2/10/2011 4:02 PM (GMT -6)   

Diamonds3’s Husband here:

I have been researching irreversible electroporation, IRE, since I was diagnosed last month; a colleague of mine mentioned it to me.  Dr. Wong is going to call me next week to give me more details, but here is what I’ve learned so far:

·         My health insurance will pay for it as it is recognized as a cancer treatment.

·         It can be preformed more than once.

·         Prostatectomy is still an option after this treatment (IRE is a minimally invasive treatment, not a surgery).  It’s ironic; apparently irreversible is reversible, while radiation is not.

·         Side effects appear to be minimal, if none at all.

·         Other patients are currently scheduled to receive IRE.

Sure, there may only be a dozen or so patients so far, and I’ll try to get more details when Dr. Wong calls me, but this is what I’ve found out while searching the net about the other patients’ results:

·         Patient #1 had a biopsy and PSA test in September (treatment in July) and the results showed no cancer in the prostate and his PSA dropped to 0.3.

·         Patient #2 received his results in November.  No cancer in the prostate and his PSA dropped to 0.1.

·         Patient # 3 got his results back this December.  No cancer in the prostate and his PSA dropped to 0.4

·         Patients # 4 – 8 results were due this past month.  Let’s all keep our fingers crossed.

·         The author of the web post where I quoted these stats from had his PSA drop from 4.3 to 0.7 just 2 months after his IRE.

After a brief conversation with the Doctor’s office I could have interpreted that the results above might be skewed as they only accept patients with Gleason scores of 7 or less, who don’t have enlarged prostates and those that have no cardiac history.  But if I’m fortunate enough to be in that group, why not assume that I could get the same results?

Other than having to travel from NJ to Atlanta, and that the treatment is “unproven”, I see no downside to pursuing IRE at this point in time.  In the not-too-distant past nerve-sparring surgery was new and unproven, as was da Vinci robotic assisted surgery, or any other PC treatment option. 

My wife and I have not ruled out surgery or radiation (either Cyberknife or proton beam).  We’re just following other contributors’ advice; to slow down and not make a rash decision, and to research treatment options as best we can.

Veteran Member

Date Joined Dec 2010
Total Posts : 3555
   Posted 2/11/2011 11:08 AM (GMT -6)   
I have done some interesting reading about this in the last few minutes. It was approved by the FDA in 2008. Just a few days ago the FDA issued a marketing warning against AngioDynamics (the developer) asserting they were making claims that went outside their approval. about 400 people worldwide have been treated, very few for prostate cancer. The Dr. Wong is at the Mazilia Clinic here in Atlanta, which is an interesting organization modeled after the Mayo and Cleveland Clinics, with funding from Bernie Marcus (one of the founders of Home Depot), and they specialize in urologic cancers.

It was developed to ablate soft tissue cancers in areas difficult or impossible to operate due to location, blood supplies, nerves, etc.....sounds like prostate surgical difficulties. It is too new to have any human clinical trials and was approved on a fast track basis.

The technology looks interesting, however the electrical impulses can wreak havoc with a weak heart. It also appears that for prostate canser it would be aimed at very early organ confined patients.

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 2/11/2011 11:22 AM (GMT -6)   

You said: "and that the treatment is “unproven”, I see no downside to pursuing IRE at this point in time."

Of course you are are free to pursue whatever treatment you desire. But you seen no downside? I must be missing a point here, the downside is that you are putting your life on the line here, and possibly a legitimate chance to stop your prostate cancer, on a questionable treatment method. You said only a "dozen or so" have been done? Doesn't that send a warning signal to you in some way?

While surgery has its risks and side effects, as well as standard radiation methods used as a primary treatment, at least they are well used and well proven treatments.

I can only speak for myself, but I would never take the risk with this new method on my own body.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Regular Member

Date Joined Sep 2010
Total Posts : 225
   Posted 2/11/2011 12:55 PM (GMT -6)   
For someone on the other side, my advice is I would not do any other treatment that has not passed the test of time and statistics if I were you since there are a number of options that could give your husband a real cure with acceptable chance of no side effects.

I did robotic. However, if I were to do it over, I would give radiation and brachy more consideration even though my outcome is "so far so good". I think both surgery and radiation has similar outcome. A good surgeon or a good radiation oncologist probably are more important in outcome and side effects than choosing either-or. Just to cite the web site from the City of Hope Hospital robotic surgery outcome (I did not use them):

"Based on our most recent data review, our pathological positive margin rate is below 20%. The average time to regain continence is about 40 days, with almost 96% of patients reporting continence at one year after surgery. Patients may be enrolled in a continence rehabilitation program to strengthen their pelvic muscles and accelerate their recovery. Furthermore, depending on age and pre-operative erectile function, approximately 70-80% of patients can expect to have return of potency with or without the use of oral medications."

These are not bad odds, considering the consequences of cancer.
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Negative margins; Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason grade 4. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 no incontinence, no ED. Jan PSA: <.1

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 2/11/2011 3:17 PM (GMT -6)   
diamonds3 & husband,
To tee-up my feedback to you, I would first reference my earilier reply to your other thread (HERE) where I talked about the treatment decision making process.  My reply included this passage:

Here’s another “tool” which I can provide for you to begin previewing.  It’s called the “Guideline for the Management of Clinically Localized Prostate Cancer:  2007 Update.”  It is a publication of the American Urological Association, and it’s available free online.  As I already stressed, you shouldn’t be making treatment decisions now, but this will help you to frame-up a decision making process.  In summary, the document guides you to closely examine four facts/dimensions about your husband in order to make the most personally appropriate treatment decision:  his cancer characteristics, his overall health, his life expectancy (age), and his personality/values. 


I followed this guideline fairly closely in my decision making process, and it left me with high confidence before, and after, my treatment that I had done the right thing…right for me.  This guideline doesn’t steer anyone toward one treatment or the other, but helps with the decision making process.  Later, if you are interested, I can/will share how I analyzed these dimensions for myself (again, my age and case sounds very similar to your husband’s).


With regard to your contemplation of IRE, I would very carefully self-examine whether your personality/values are such that you are willing to be a "pioneer"...basically, part of an experiment before the tweaks and adjustments are made that come with cycles-of-learning.  I guess that somebody has to step forward to be a pioneer (God bless them!), but I just know that it wouldn't be me.


Cancer control is measured in years...and at your age you should be concerned about many years.  Look at HIFU...very immature process (but more mature than IRE), lots of early (positive) hype, but now being shown to be poor at cancer control, and causing increasing numbers of problems a year or two or three down the road.


One thing I've learned...I want the best care possible.





edit:  activated link to old post

Post Edited (Casey59) : 2/11/2011 2:22:05 PM (GMT-7)

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