Welcome to this site. I'm sorry to hear about
George's diagnosis, but Memorial Sloan Kettering is one of the best. I applaud his doctor for offering you two very good alternatives to radical (whole gland) therapy.
I didn't have NanoKnife (focal electroporation), and I will be very much surprised if anyone here has. It's quite new and is in clinical trials. I thought it was only in clinical trials in Europe, but apparently MSK is trying it as well. If your doctor has treated anyone else with it, he may be able to give you permission to talk to that person.
Coincidentally, I'll be on an internet radio panel next week to discuss focal therapies. The interview is with Mark Emberton of University College Hospital in London. He is the lead investigator of the clinical trial there of Nanoknife focal therapy, and I plan to ask him about
it. He is a leader in the field of focal therapy, and has had great results with focal HIFU. You might want to listen in and call in if you have any questions for him. Here's the link:Focal Therapy and HIFU for Prostate Cancer with Dr. Mark Emberton on The Cure Panel Talk Show
I'm a little surprised that focal therapy is an option with 3 positive cores and in both lobes, as I've usually only seen it for 2 or fewer cores on one side. (btw - I think his stage with MRI-detected involvement on both lobes would be T2C). You didn't mention the percent of those 3 cores that were cancerous, but I assume it was low.
In over 10 years of tracking, active surveillance (AS) has been shown to be a very safe option in well-selected men. Is there any long-term benefit in terms of side effects or survival between AS and focal therapy? Two-thirds of men on AS do not have any kind of interventional therapy out to 10 years. Ideally there would be a clinical trial where half the men were randomly assigned to focal therapy and half to AS, and their side effects and prostate cancer survival would be tracked until they died of that, or more likely, of something else. (My guess is there would be no difference.)
Lacking that kind of study, a lot of the decision between focal therapy and AS centers around the psychological benefits. After all, when we hear the word "cancer" it is a natural reaction to want to do something proactive about
it. But, because PC is most often a multifocal disease and there can never be 100% assurance that the focal therapy got it all, the patient is effectively on AS for the rest of his life anyway. Every man has to decide for himself what he can live with.