Electrical pulse ablation technology has been around a while, with multiple studies performed and a large body of patents. The promise and hope for the technology is that is causes cell apoptosis, and early rat studies showed electrical ablation shrinking tumors. The goal was/is to apply it to multiple cancer types. Source: I helped with one of the pioneering companies in the field.
Sample size n=1, but my dad was on the research or clinical trial of this exact treatment in Sydney, it worked for his prostate cancer, he's still clear from PSA tests (and possibly had biopsy also. No side effects.
Previously he'd had the radioactive beads treatment which failed, the only other option was removal. Both these options have potentially unpleasant side effects.
Happy to ask him questions if anyone wants to know more
Would you be interested in chatting more about the whole experience? breck@cancerdb.com or 1-808-727-1111
I've been in Cancer Research for 5 years and am now starting my own idea to help (utilizing my background in software engineering and data science): CancerDB.com a public domain ad-free knowledge graph. The idea is to get a core group of researchers collating all the data into one place that's accessible by both patients, families, caregivers, and researchers.
"After a full workup to ensure that our patients are suitable for the program they then undergo a day surgery procedure which takes between 40 and 60 minutes. Depending on the extent of the cancer this may simply ablate the lesion, a quarter of the prostate or a half of the prostate. No prostate cancer cells are resistant to this treatment. Large areas can be treated with minimal side effects.
After the treatment patients stay in the day surgery unit for two to four hours and they are discharged home with a Foley catheter in place. Postoperatively pain is minimal and patients are discharged with tablets for mild pain, moderate pain, bladder spasms and relaxation of the prostate and antibiotics as required.
On day 2 a limited multiparametric MRI is performed. The Foley catheter is left in for two to five days depending on the extent of the treatment."
My father had an aggressive form of prostate cancer that required removal. He was put under at a hospital. The surgery wasn’t very long and the procedure wasn’t too invasive.
Recovery wasn’t so bad but you have a catheter for a bit. Cancer drugs and all but no hair loss. IIRC, he was very low energy. He’s been cancer free for over a decade.
There’s a chance you can lose the capability to get an erection so you’ll want a good surgeon (I did not discuss this with my dad). Another person I knew had to wear a small pad because he could have a small amount of urine dribble. He said he could pee like a horse and it was much easier post op.
May I ask how this was discovered in your dad's case? I feel like prostate cancer is the single most dangerous cancer for men in the late 30s, 40s, and 50s. So it's a subject I'm trying to pay attention to.
He had a change in PSA levels in his blood - it's a good idea to get your bloods checked annually so you can pick up any changes, as PSA levels vary a lot person to person.
Also gan get "the finger" to see if you have an enlarged prostate.
I think as far as cancers go, prostate is one of the better ones to get, not normally aggressive, you'll probably die before it kills you.
No way, colorectal and lung (even if you're a non-smoker, worse prognosis) are both relatively very common and will kill you quickly.
We're seeing a lot of early presentations in both contributing to the lower screening start by the USPTF, evidence still coming in on lung and what to do.
I was diagnosed with prostate cancer when I was about 57. I had had somewhat regular "finger up the butt" exams prior to that, since I was about 45, which were all negative. Then a PSA blood test test came back positive and I then had a biopsy done (no fun, trust me). Because I was still in my 50's I needed to do something beyond just continuing to monitor it. Between radiation treatment and a prostatectomy I chose the latter. Eight years or so later my PSA tests are still negative, knock on wood. Lesson learned, I think, is to get a simple PSA blood test done regularly once you've reached a certain age.
I don't think you can conclude that from one patient, that's not how medicine works.
Whether to actively surveil vs treat depends on individual patient characteristics and grade (generally Gleason 7+) and the fact that you didn't have a complication does not mean they're not sufficiently high. On a population level analysis the evidence clearly support that there is no improved mortality with prostate cancer screening.
Basically they insert somewhere between two and a handful 1mm diameter needles, then pulse with high voltage to kill the cells in between.
The article mentioned concerns from doctors that it hadn't been through large clinical trials yet. 13 years later, does anyone know of those trials have taken place?
In a past life, I worked in prostate cancer ("PCa") clinical research. To drive home the point about how large of an unmet need this is:
A) In addition to 1/6 men being diagnosed with PCa, an ~equally large percentage of men have undiagnosed cancer at the time of death, it just wasn't severe enough yet to be the thing that killed them. (1)
B) Because treatment carries a 50% risk of sexual and/or urinary dysfunction side effects, the standard of care in the US for PCa is literally to leave the cancer untreated and monitor it closely, until it develops into an aggressive cancer. At that point, we treat the entire prostate (the opposite of "focal" therapy referenced in this article) and all bets are off re: side effects. Also, often by that time, the cancer has spread outside of the prostate and is much more difficult to treat.
Most current cancer treatment methods we have are basically sledgehammers with loads of collateral damage - it’s not surprising the preference is to leave it if it’s benign.
My father died from metastasized prostate cancer. If/when I get it I won’t do “watchful waiting”. I’m going to get the most aggressive treatment possible.
Is there anything about this that is specific to the prostate? Wouldn't this exact same treatment work on other accessible tumors, for example breast or skin?
It was incurable and his life expectancy was estimated in months at that point. I'm not too sure if a "stage" was defined. His outlook largely depended on how further rounds of unpleasant chemo went - whereas Nanoknife, as far as I recall, was a single day out-patient thing (?)
I recall him telling me that he asked the staff how long it would be before they could start and they told him they were about half way through!
Quality of life: damage to the pancreas was not reversible, but the tumour was very much reduced and there was no further deterioration for a good while. For usnit was worth it (despite not being available on the NHS at that time).
Irreversible electroporation isn’t that new, it’s being actively used (i.e. not trials) for liver, lung, pancreas and kidney cancers for a few years now.
We use it quite a bit in radiology. Usually faster / easier to use thermal ablation (microwave or cryo these days, used to be radiofrequency more often) but there are cases where it’s not feasible due to heat sinking or other reasons and IRE is an alternative.
Be careful with this statement, early diagnosis is key to survival for certain conditions. In many cases it has not resulted in improved mortality, prostate cancer being one of them.
Many health care provision systems don't invest in screening tests or other early-detection schemes, or they do make them available, but don't invest in raising awareness of their availability. I'm actually now at the age where I should start thinking about "What new periodic tests/checkups should you introduce within the next 5 years?" ... and at this point I'm still clueless, except that I know that at around 50 I should start getting my PSA checked.
Beware: more testing does not imply better outcomes. There are many situations where a test result may show something that apparently "need to be addressed", but the side effects and problems caused by "addressing" that result is, on average, worse than the result of never having tested in the first place.
Of course, many tests are valuable, with results that can lead to effective treatment. But, it's hard to know which is which without significant study.
I don't know about "should", it's a conversation you should have without your doctor (at age 55-69) as it's not without risks (2/3 false positives, if you need a biopsy literature is 3% infection rate requiring hospitalization. Although the advent of prostate MRI may obviate some biopsies, it's still center specific. This will probably change but we don't have enough evidence yet to support this as screening (or to not do a random biopsy if the MRI is negative for clinically significant cancer). In any case most prostate cancers detected this way are low grade and watched with active surveillance anyway.
There is medium evidence that PSA screening does not improve overall mortality, strong evidence of harms and moderate evidence to support early detection for overall weak recommendations (grade C) to consider screening in 55-69 (50 in US and EU) for patients who decide they want it after shared decision making[0-3].
I definitely would not say that everyone should, it's a personal decision after a discussion. As a physician I personally wouldn't.
Note the guidelines differ for carriers of certain genetic mutations or are high risk.
> Many health care provision systems don't invest in screening tests or other early-detection schemes, or they do make them available, but don't invest in raising awareness of their availability.
This is a stretch, I'm not sure where you're living but this is not true in US, to a minimal extent in Canada (we still require GPs to send requisitions for mammograms in patients age 40-49 but the screening program covers 50 in spite of newer guidelines but we definitely provide age-approriate screening oral), and should not be in major European countries based on their own guidelines.
The reason no one is pushing PSA screening on you is because most physicians don't believe it and the recommendations themselves are very weak, only in patients who themselves desire it.
It's a screening blood test which, when positive, makes you go get a more serious exam. So the effect of a false positive is that you get, say, an MRI. So at worst, 3x the required number of MRIs will be taken due to such screening. It's not even excessive irradiation of people.
> we don't have enough evidence yet to support this as screening
For the general population, you may be right, I'm not an epidemiologist. For people with a strong family history of prostate cancer it's a different story. The point is the different people need to consider different checkups based on their personal medical situation and family history.
> literature is 3% infection rate requiring hospitalization
Prostate cancer rarely requires hospitalization - unless you do nothing about it for so long that it metastasizes. Otherwise, treatment is typically as an outpatient. So that metric is also not really relevant I would say.
> PSA screening does not improve overall mortality
Again, wrong metric. You can wait until symptoms appear and still have very low chances of mortality, but the damage due to treatment is much more significant.
The point is to catch the prostate cancer early enough, that treatment can get rid of it with very little damage to surrounding tissue.
> this is not true in US, to a minimal extent in Canada
In the US, a large part of the population is not even cared for medically: There is no universal automatic coverage of residents.
Also - medical health providers can easily bring up arguments such as those you have brought up, to avoid screening even conditionally for various health risks.
So I believe you have an overly lenient evaluation of screening policies.
> The reason no one is pushing PSA screening on you is because most physicians don't believe it
Based on your questionable choice of arguments and facts, I am not very credulous that this statement is indeed true, and that a proper survey with the proper question and relevant information has been put to the relevant physicians.
At any rate, at least first link you gave, to the description of the issue by the AUA, is very saddening, because they also mis-represent the dilemma, and apparently aren't bothered about people's quality of life as long as they don't die. I've been told otherwise by more than one Eurologist, and with an insistence to the degree of making me set a phone calendar appointment several years from now to remind me to go get my first PSA blood test.
> It's a screening blood test which, when positive, makes you go get a more serious exam. So the effect of a false positive is that you get, say, an MRI. So at worst, 3x the required number of MRIs will be taken due to such screening. It's not even excessive irradiation of people.
Actually it’s not, prostate MRI is still new and a positive PSA with negative MRI will still get a biopsy, some “centers of excellence” may practice differently but I trained in the highest volume prostate MRI center in North America and this is certainly not the case at the moment. There is insufficient evidence to support your claim that we can stop at MRI at this time.
> For people with a strong family history of prostate cancer it's a different story. The point is the different people need to consider different checkups based on their personal medical situation and family history.
This is included in our guidelines which are intended for average risk patients. There is insufficient evidence to come down hard for high risk patients (1st degree relative < 65 at diagnosis being one) hence why it’s a shared decision making process. Most people screen this group of patients in my practice experience.
> Prostate cancer rarely requires hospitalization
This is the hospitalization rate for BIOPSY. Even metastatic prostate cancer rarely requires hospitalization.
> The point is to catch the prostate cancer early enough, that treatment can get rid of it with very little damage to surrounding tissue.
I’m not sure how you think this is true. Robotic prostatectomies and curative intent radiation are the standard of care for organ defined disease (representing 90-95% of cases detected WITHOUT screening, obviously higher with) and both carry significant risks of impotence and incotinence.
First line treatment of disseminated disease is androgen deprivation which actually isn’t as morbid as you claim.
> Also - medical health providers can easily bring up arguments such as those you have brought up, to avoid screening even conditionally for various health risks.
So I believe you have an overly lenient evaluation of screening policies.
Every doctor practices evidence based medicine. The USPTF, AUA and EUA/ESUR all recommend against routine screening. There is a proposal right now in Europe to re-evaluate this recommendation given the emergence of prostate MRI and potential to avoid biopsy but again we’re getting into experimental/emerging areas hence why this is a /discussion/ with your provider and participating in /shared decision making/ rather than telling everyone “go get your PSA screen”.
I’m not sure why you’re calling every major societal guideline a questionable choice of evidence? We practice evidence based medicine not science based medicine.
PSA screening WAS a thing until studies came out showing harm and the USPTF changed their recommendation.
Some urologist like following PSA in average-risk patients because it’s a quick and easy billing visit. I assure you the physician societies all consider patient morbidity when making these recommendations, overall mortality is still the most important metric in medical research because it is the least subjective to bias. As discussed above the treatment options for disseminated disease have low morbidity and the treatment options for confined disease have similar-higher morbidity.
What is saddening about the AUA perspective or the dilemma the medical society is failing to understand? Can you provide any evidence to suggest prostate cancer screening reduces morbidity?
I'll take an uneducated guess here: this works best for small and clearly defined tumors. You would have a hard time causing electroporation of cell membranes farther away from the electrodes without damaging too much healthy tissue.
Oddly enough I've just been looking into a veterinary treatment method for superficial tumours based around cytostatica in combination with electric pulses - delivered by a pulse generator controlled by a Raspberry Pi - which are supposed to increase the efficacy of the cytostatica by 'electroporation' [1]. I'm mostly looking into this because the glossy site and the presentation given at my wife's vet clinic have a relatively high snake oil coefficient although there is some science [2] behind the process. It seems to come down to a combination of a TENS machine [3] (which can be had for around £40-60, ₤80 if you want it remotely controlled through your phone) with needle probes except for the fact that a 10-pack of 4-needle probes costs €2.500 while the machine itself - a Raspberry Pi with a keyboard, a pulse generator and an LCD screen in a compact box - costs around €25.000...
Why do you assume that I am testing 'this' on animals? Why do you ask whether I have 'actual medical training'? How do you think the original product was developed?
Not so much in response to this rather grandstanding appeal to authority but just to describe how a product like this can be developed I can state that my wife is a veterinarian specialised in horses while I am a developer with a lot of experience in developing hard- and software. If we wanted to develop something like this we certainly could and maybe we will. Medical technology is not magic after all, the process which lies behind this system is known and has been researched [1] extensively - not by those who built the €25.000 unit, they just did what you insinuated we should not do.
My uncle recently had this procedure here in the US. His hospital tried to push him quickly toward a surgical option, but he did his own research and eventually found this. It cost him $15k out of pocket, he now has a clean bill of health, and as a bonus he avoided potential/likely erectile dysfunction.
In medical school, one of my mother's classes had an exercise one day which took this form:
Here are a bunch of slides of prostate samples. Find the cancerous one.
This led to the teacher getting so many questions about whether the slide someone was currently looking at was the cancerous one that he was forced to interrupt the class to make this more general announcement:
There's a bit of cancer in everyone's prostate. Find the slide with obvious cancer.
I'm not a doctor, but my understanding has been that we all have cancer cells at any given point in time. Consider how many cells inside you are undergoing cell division; errors in cell division are where cancer cells come from.
The question is whether your body sees and kills the cancer cells; most of the time it does, which is why most of us can live pleasantly for most of our lives despite errors cropping up silently. What we term cancer are the cancer cells that slipped past our body's defences, growing into masses that cause no end of grief.
To put it in computer terms, it's like error correction in HDDs and SSDs and ethernet connections. Errors are inevitably going to occur while data is in transit, but they are of no concern so long as error correction and other such mechanisms can correct and recover. The errors do become a concern when they start slipping past such mechanisms, however.
This is my understanding as well and my favorite protein, p53 [1], is responsible for hunting down cancerous cells. From what I remember reading in Robins Basic Pathology, it takes many steps for a cell to evolve into cancer and our body has ways to reduce the probability at each step. The most fascinating topic to me is how someone's lifestyle and environment affect their body's natural cancer defence mechanisms. We can do many things to stack the odds in our favour, but sometimes the odds are still not in our favour. Should we strive to minimize the chance by adjusting our lifestyle and changing the environment, or strive for some kind of balance?
Elephants have 100x as many cells as a human does, live about as long, but have about 1/2 the chance of dying of cancer. Why? A big part is that each elephant cell has ~40 copies of the p53 gene.
>Should we strive to minimize the chance by adjusting our lifestyle and changing the environment, or strive for some kind of balance?
That is as much a philosophical question as it is biological, and one where the answer will vary by who is asked.
Personally, I will say this: If you're miserable while endeavouring to prevent cancer (or any other disease), that's putting the cart before the horse. The goal is, presumably after all, to live happily.
That's my understanding too. But we're talking about cancer that can be observed on a slide. At that point, that's beyond the error correction mechanisms AFAIK.
You're probably correct as to babies. But the prostate gland is extremely cancerous and my assumption would be that that tendency begins at either birth or puberty. The exponential function spends the entire infinite length of the negative x-axis rising from 0 to 1; think about the growth of cancer in your prostate gland that way.
I would not expect a man in his late 20s to fall into the category "men of an advanced age". But I would be unsurprised to learn that there was visible protocancer in a sample of his prostate.
Someone I knew had the slow-growing case for quite some time. Then, it abruptly without warning turned into the aggressive form and killed him. Makes it very difficult to know what to expect. I guess frequent checks are necessary, because once its evident, you're already in a world of trouble...
The stats are still pretty bad. Prostate cancer kills more people than breast cancer (though it's usually men in their 80s, so the QALYS is not as bad). A prostate cancer diagnosis is not terrible (since it's so damn common) and aggressive treatment and overly-aggressive screening might be a bad idea in most cases (since it's often best to not worry too much - over-treatment and even over-testing has its costs) but there's certainly a need for better treatment in cases where it does get bad (which is a very sizable number of older men).
Doctors don't try to do the test on every man over 55 without a good reason.
Not sure where you're getting your stats from. In both US and Canada this isn't true.
There are an estimated 43,780 deaths attributable to breast cancer and 34,500 to prostate cancer in the US for 2022[0] and 5555 vs 4600 respectively in Canada. This is spite of aggressive screening and early treatment vs not really for prostate cancer.
But, curiously, they stop testing at 70 (or was it 72?). That's what my urologist told me last year when I had my exam. Ever since my father had prostate cancer, I've had a yearly PSA and exam by a urologist (thinking that a urologist will be better at detecting tumors than a GP/PCP).
There is weak evidence to support testing over 70 due to increasing risks of biopsy/treatment and no evidence to support improved overall mortality.
Some guidelines suggest that it's reasonable to continue in patients with >10-15 year life expectancy if the patient desires, but there is no strong recommendation or evidence to support this recommendation or screening in this age group.
Some guidelines actually have a strong recommendation to stop screening men with < 15 year life expectancy.
Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening.
> Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening.
I believe my father's prostate cancer was found via DRE and not PSA. That is, PSA was in the normal range. That is what made me get a DRE from a urologist once a year (since then).
It’s hard to comment accurately as prostate cancer isn’t a single disease.
PSA cutoff trades sensitivity and specificity. It isn’t a binary positive/negative.
There are certain highly aggressive but very rare subtypes (e.g. neuroendocrine) that will present with low PSA levels. Rarely an aggressive adenocarcinoma (Gleason 8+) will present with low PSA. Screen detected prostate cancers with low PSA are most likely clinically insignificant [0].
If you are known to have a first degree relative with a rare subtype then routine screening guidelines don’t apply to your circumstance.
Important points to keep in mind:
Just because a prostate cancer is “found” it doesn’t mean it needs to be treated.
There is no survival benefit when comparing treating early prostate adenocarcinoma (conventional and most common type representing 99% of prostate cancers) at very low PSA vs using 4ng/mL as a cutoff.
There are verifiable and proven harms with over treatment of low grade prostate cancer, workup of a “nodule” felt on DRE in the context of normal PSA is more likely to harm a patient than benefit them even if cancerous which forms the basis of current guidelines.
All forms of cancer screening will have edge cases that are missed. Even in your father’s case only the peripheral zone is palpable by DRE (would miss transitional zone or 20% of cancers). When considering recommendations to make at a population level harms vs benefits have to be carefully weighed, in the case of prostate the evidence strongly suggests against DRE, and weakly against prostate cancer screening in general.
Looking towards the future, there is probably a role for prostate MRI somewhere which is good at detecting clinically significant (Gleason 7+) cancers but this is still being actively studied and we don’t have enough evidence at this time to support screening.
How credible is this paper? I see it's highly cited, but I also see that it claims that fungi are cancer causing but not also cancer preventing, which seems questionable.
> Over one third of cancer deaths worldwide (and about 75–80% in the United States) are potentially avoidable by reducing exposure to known factors.
> Common environmental factors that contribute to cancer death include exposure to different chemical and physical agents (tobacco use accounts for 25–30% of cancer deaths), environmental pollutants, diet and obesity (30–35%), infections (15–20%), and radiation (both ionizing and non-ionizing, up to 10%).
> less than 0.3% of the population are carriers of a cancer-related genetic mutation and these make up less than 3–10% of all cancer cases.
I had PC in my early 40s, over 15 years ago now. If that treatment had been available then I might still opt for surgical removal. The peace of mind of getting the thing out is huge and the side effects for me were negligible, as I had a great surgeon and recovery for younger patients is pretty good.
In my 60s I would definitely go for something like this although I'm always a little leery of treatments that have cool sounding brand names.
I heard an interview on one of NPR shows last week and the guest talked about using electricity for healing. For example, if I remember correctly, a wound treated in someway with electricity healed faster. It had something to do with stimulating the cells in a particular way.
Side note: Does this give any credibility to the idea that magnets can heal?
The mechanism used here is that high voltage causes cells to open channels through the cell wall, letting good cell stuff out and bad stuff in. Do it enough and the cell will die. I'm no biologist but I don't know of a similar magnetic mechanism.
I was thinking that if high voltage power lines produce a magnetic field, perhaps a magnetic field can influence energy in cells? Again, it's an idea inspired by the interview I heard.
Yes. But I also reference how electric currents / fields are being researched for healing / regenerative purposes. The crux of that seems to be how to influence the energy properties cells already have.
Only initial cancer or mets as well? When can this be realistically tested on real humans? How long? I have a close relative with potential biochemical recurrence. Could this save him?
My reply is totally against the guidelines, but the image of some bio-curious hacker sticking needles in the perineum and putting high voltages on them in a home lab is such an absurd mixture of horror and embarassement that your sane reply had me in stitches.
Does this mean you need access to a MRI machine?
"Guided by MRI scanning, the short pulses can be targeted to the right area, and surrounding healthy cells are left untouched and preserved, experts said."
This has been debunked for generations, much like orgone. People have gone to JAIL for suggesting that you can use electricity to cure diseases such as cancer.
A quick internet search for "electrical ablation cell apoptosis cancer" yields a few research articles. For example https://www.frontiersin.org/articles/10.3389/fonc.2020.01235...
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