5 ms·

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?

by ars 4y ago

iSnow 4y ago
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.
CommanderData 4y ago
I read its effective at treating lung and liver cancers too. Early diagnosis is key to survival.
- einpoklum 4y ago
  Your second sentence merits millions of upvotes. 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.
  - dtgriscom 4y ago
    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. Refs: https://www.npr.org/sections/health-shots/2022/06/13/1104141886/cascade-of-care https://www.npr.org/sections/health-shots/2022/06/13/1104141... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628817/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628817/ https://www.americanpatient.org/medical-tests-to-avoid-that-may-endanger-your-health/ https://www.americanpatient.org/medical-tests-to-avoid-that-...
  - haldujai 4y ago
    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. [0]https://www.auanet.org/guidelines-and-quality/guidelines/prostate-cancer-early-detection-guideline#x2626 https://www.auanet.org/guidelines-and-quality/guidelines/pro... [1]https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme... [2]https://www.cua.org/system/files/Guideline-Files/7851_v6_1.pdf https://www.cua.org/system/files/Guideline-Files/7851_v6_1.p... [3]https://uroweb.org/guidelines/prostate-cancer/chapter/diagnostic-evaluation https://uroweb.org/guidelines/prostate-cancer/chapter/diagno...
    - einpoklum 4y ago
      > 2/3 false positives 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.
- haldujai 4y ago
  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. This is so well known we have terms to describe the phenomenon. https://en.wikipedia.org/wiki/Length_time_bias https://en.wikipedia.org/wiki/Length_time_bias
dcminter 4y ago
My father had Nanoknife for pancreatic cancer; it wasn't a cure, but it reduced the tumour enough to buy him another couple of years.
- z3c0 4y ago
  Incredible. Arguably the most vicious form, so hearing that it could buy so much time is awesome. Nonetheless, I'm sorry for your loss.
- agumonkey 4y ago
  Was he having a good quality of life after the operation? Also what stage was he at when they used this procedure?
  - dcminter 4y ago
    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).
    - agumonkey 4y ago
      > 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! that's the therapies we want to see more of happy that your family could enjoy some more time take care
haldujai 4y ago
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.

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?

by ars 4y ago

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?

iSnow 4y ago

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.

CommanderData 4y ago

I read its effective at treating lung and liver cancers too. Early diagnosis is key to survival.

einpoklum 4y ago
Your second sentence merits millions of upvotes. 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.
- dtgriscom 4y ago
  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. Refs: https://www.npr.org/sections/health-shots/2022/06/13/1104141886/cascade-of-care https://www.npr.org/sections/health-shots/2022/06/13/1104141... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628817/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628817/ https://www.americanpatient.org/medical-tests-to-avoid-that-may-endanger-your-health/ https://www.americanpatient.org/medical-tests-to-avoid-that-...
- haldujai 4y ago
  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. [0]https://www.auanet.org/guidelines-and-quality/guidelines/prostate-cancer-early-detection-guideline#x2626 https://www.auanet.org/guidelines-and-quality/guidelines/pro... [1]https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme... [2]https://www.cua.org/system/files/Guideline-Files/7851_v6_1.pdf https://www.cua.org/system/files/Guideline-Files/7851_v6_1.p... [3]https://uroweb.org/guidelines/prostate-cancer/chapter/diagnostic-evaluation https://uroweb.org/guidelines/prostate-cancer/chapter/diagno...
  - einpoklum 4y ago
    > 2/3 false positives 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.
haldujai 4y ago
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. This is so well known we have terms to describe the phenomenon. https://en.wikipedia.org/wiki/Length_time_bias https://en.wikipedia.org/wiki/Length_time_bias

dcminter 4y ago

My father had Nanoknife for pancreatic cancer; it wasn't a cure, but it reduced the tumour enough to buy him another couple of years.

z3c0 4y ago
Incredible. Arguably the most vicious form, so hearing that it could buy so much time is awesome. Nonetheless, I'm sorry for your loss.
agumonkey 4y ago
Was he having a good quality of life after the operation? Also what stage was he at when they used this procedure?
- dcminter 4y ago
  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).
  - agumonkey 4y ago
    > 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! that's the therapies we want to see more of happy that your family could enjoy some more time take care

haldujai 4y ago

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.