Precision Without Heat: Irreversible Electroporation for Prostate Cancer
Individualized treatment, guided by anatomy, cancer biology, and your priorities.
Welcome to our Prostate Irreversible Electroporation (IRE / NanoKnife®) resource. For select patients with localized prostate cancer, IRE is a focal, non-thermal ablative technology that uses electrical fields to induce cancer cell death while preserving surrounding critical structures. This approach is designed to minimize collateral tissue injury and functional side effects. Our role is to provide a comprehensive, evidence-based discussion to determine whether IRE is an appropriate option for your individual cancer characteristics and treatment goals.
-Jonathan Hu. MD
SVU
If you haven’t done so already please read more about prostate cancer
Prostate Cancer
What is IRE?
Irreversible Electroporation (IRE), commonly referred to as NanoKnife, is an advanced focal therapy option for select men with localized prostate cancer. This technology uses precisely delivered electrical pulses to disrupt cancer cell membranes, leading to cell death while preserving surrounding critical structures. Unlike thermal treatments, IRE does not rely on heat or freezing, allowing for a high degree of anatomic precision.
At Santa Cruz Urology, Prostate IRE is offered as part of a personalized, tissue-preserving approach to prostate cancer care, with a focus on oncologic control while minimizing impact on urinary and sexual function.
The Procedure
IRE uses thin needle electrodes that are placed directly into the prostate under image guidance. Short electrical pulses are delivered between the electrodes, creating permanent pores in cancer cell membranes. This process leads to apoptosis without damaging connective tissue, blood vessels, nerves, or the urethra. Because the prostate’s structural framework is preserved, healing occurs with less scarring and distortion compared to thermal therapies.
Who May Be a Candidate for IRE?
IRE is generally considered for men with localized prostate cancer who wish to pursue a focal, tissue-sparing approach. Ideal candidates often have low- to intermediate-risk disease confined to a defined area of the prostate. Candidacy is determined through multiparametric MRI, targeted biopsy, PSA trends, prostate anatomy, and overall health status. A thorough evaluation is essential to ensure oncologic safety and realistic expectations.
Benefits of Prostate IRE
IRE offers a targeted approach that aims to preserve quality of life while treating clinically significant cancer. Potential advantages include reduced risk of urinary incontinence, lower impact on erectile function compared to whole-gland treatments, and preservation of surrounding critical anatomy. The procedure is typically performed under general anesthesia with a short recovery period.
Risks
As with any prostate procedure, IRE carries risks, including urinary retention, infection, temporary urinary or sexual changes, and the possibility of incomplete cancer ablation requiring additional treatment. While early and mid-term data are encouraging, long-term outcomes continue to be studied. A detailed discussion of risks, benefits, and alternatives is an essential part of shared decision-making.
Outpatient
Home same day
Non-Invasive
100% No surgery or radiation
Personalized
Targeted Treatment
Is IRE right for me?
Suitable candidates for IRE typically have localized prostate cancer that hasn’t spread to other areas of the body, ideally presenting low-to-intermediate risk. Evaluation involves imaging such as MRI, ultrasound, and targeted prostate biopsy to determine eligibility.
- Confirmed Prostate Cancer Diagnosis
- Ensure localized prostate cancer
- Ideally region of interest (ROI) is focal
- Rectum that is accessible
- Willing to continue 1-2 yearly MRI and biopsies
Pre Operative
Your safety is our top priority. We collaborate closely with your primary care physician and/or cardiologist to ensure a safe and smooth procedure for you.
- Surgical Clearance from your primary care or cardiologist (Bloodwork and EKG/Chest X-Ray)
- Informed Consent
- Fleet enema of the rectum (2x) 2 hour before to ensure empty rectum
- Nothing to eat or drink per facility anesthesia protocol
Intra Operative
Following anesthesia, the duration of planning, contouring, and interpreting images for your personalized treatment will typically take about 30 minutes, depending on the size and shape of your prostate. Subsequently, the treatment itself usually lasts for 1-2 hours.
- Undergo anesthesia
- Ensure the rectum is clear of feces
- Foley catheter will be placed while you are asleep
- Surgeon will plan, contour and shape the treatment zone
- Treatment will start
- Removal of probe
Post Operative
After the procedure, you’ll be transferred to the Post-Anesthetic Care Unit (PACU) for monitoring and recovery from anesthesia. Once approved by the anesthesiologist, you’ll either be cleared to go home or, in case of any complications, may require a hospital stay.
- Foley catheter will remain in the bladder and urethra
- Nurses will teach you how to take care of the Foley Catheter
- After you are cleared you will go home with the Foley Catheter
- Follow up in the clinic for foley catheter removal or learn how to remove it at home
- Nothing per rectum for 1 month
Follow Up
After treatment you may have some catheter discomfort this is normal until you get used to it or the foley is removed. Typically we do not give medication as there are more side effects than benefits.
- Clinic for foley removal and voiding trial
- Bloodwork in 3 months
- Bloodwork in 6 months
- Bloodwork, MRI and prostate biopsy at 12 months
- Repeat until shared decision making
F.A.Q.
Roughly 2/3 of patients do well after IRE and do not need further treatment.
Even following IRE, individuals may explore salvage options such as repeat IRE, HIFU, surgery, or radiation. Opting for IRE initially does not preclude the possibility of pursuing alternative modalities later, ensuring a flexible approach to prostate cancer management without closing off other potential avenues
The majority of men can return to their usual activities within 1 to 2 days after the procedure, including regular short walks. More vigorous physical activities can be resumed after the removal of the catheter. Notably, there is no need for incision care or stitches removal, streamlining the recovery process.
I conduct a non-opioid procedure. Patients typically experience catheter discomfort, which is effectively managed with over-the-counter pain relievers like Tylenol or Ibuprofen.
Insurance coverage can differ between patients, with some offering coverage while others may not. For personalized assistance and to navigate the unique policies of each insurance provider, I recommend contacting our billing department.