A gland-sparing treatment that uses brief electrical pulses to destroy a targeted area of prostate tumor while trying to protect urinary and sexual function. For men with early, localized disease, it offers a middle path between monitoring and whole-gland surgery or radiation. Short- and medium-term cancer control looks favorable, but long-term evidence remains young and unsettled. (Full Review)

Protocol

Standard Approach

mpMRI + biopsy, then electrodes

Transperineal needle electrodes placed around the lesion under general anesthesia with full muscle relaxation and ECG-synchronized pulsing

Procedure Parameters

~1,500 V pulse trains

Dozens of short high-voltage pulses between paired electrodes spaced roughly 1–2 cm apart, guided by ultrasound and planning software

Best Timing

One-time procedure

No time-of-day dosing; scheduling driven by anesthesia fitness, cessation of blood thinners, and resolution of any active urinary infection

Time to effect

Cancer Control

Confirmed ~12 mo

Ablation is immediate; PSA reaches a lower nadir by 3–6 months and the in-field biopsy at ~12 months confirms control

Urinary Continence

Baseline in most men

Continence returns to baseline in the large majority; most transient urinary symptoms resolve within 4–6 weeks

Erectile Function

6–12 months

Erections sufficient for intercourse return toward baseline by 6–12 months in many men; results are conflicted

Benefits

Medium: In-field cancer control; urinary continence preservation; erectile function preservation (conflicted)

Low: Short-term metastasis-free and cancer-specific survival; ejaculatory function preservation; preservation of future treatment options

Speculative: Local immunomodulation

Contraindications

High-risk or locally advanced disease (Grade Group ≥ 4, PSA > 20 ng/mL, stage ≥ cT3, or metastatic)

Cardiac implantable electronic device (pacemaker or defibrillator) or significant arrhythmia

Unfit for general anesthesia

Heavily calcified or very large gland

Key Interactions

Anticoagulants (warfarin, apixaban, rivaroxaban) and antiplatelet agents (aspirin, clopidogrel)

QT-prolonging or arrhythmia-provoking drugs

NSAIDs (ibuprofen, naproxen) and aspirin

Blood-thinning supplements (fish oil/omega-3, vitamin E, ginkgo, garlic, high-dose curcumin)

Combined bleeding-risk agents (supplements plus anticoagulants)

Prior or planned radiation, hormone therapy (ADT), or previous transurethral resection

Risk & Side Effects

High: Transient lower urinary and genital symptoms; erectile dysfunction (conflicted)

Medium: Urinary tract infection and acute urinary retention; treatment failure and recurrence requiring retreatment

Low: Rectourethral fistula and rectal injury; urethral stricture or bladder neck contracture; procedure-related cardiac arrhythmia

Speculative: Long-term oncologic failure from understaging or undertreatment

Monitoring

Marker	Target	Why
PSA (prostate-specific antigen)	Stable low nadir; no confirmed rise > ~2 ng/mL above nadir	Tracks residual or recurrent cancer activity
PSA nadir	Reached by ~3–6 months post-treatment	A higher or rising nadir signals possible in-field failure
PSA density	Lower is better; trend down or stable	Adjusts PSA for gland size to improve recurrence detection
Testosterone (total)	Age-appropriate mid-normal (~400–700 ng/dL)	Confirms PSA is not artificially suppressed by low testosterone or hormone therapy

Cadence: PSA every 3 months for the first year, then every 6 months; mpMRI at 6–12 months; mandatory in-field biopsy at ~12 months; periodic imaging and biopsy thereafter

Qualitative Assessment

Urinary continence (pads used per day and leakage episodes)
Lower urinary tract symptoms (stream strength, urgency, frequency, nighttime urination)
Erectile function (erections sufficient for intercourse, with or without medication)
Ejaculatory function (presence and volume of ejaculate)
Energy, mood, and treatment-related anxiety or sleep disturbance

NanoKnife to Treat Prostate Cancer

Protocol

Benefits

Risk & Side Effects

Monitoring

Qualitative Assessment