Kevin Brailey pictured with his wife Sue. Tauranga based surgeon Mark Fraundorfer performed a new procedure for prostate cancer on Kevin. Photo/ Fiona Goodall
Kevin Brailey pictured with his wife Sue. Tauranga based surgeon Mark Fraundorfer performed a new procedure for prostate cancer on Kevin. Photo/ Fiona Goodall
A pioneering new treatment for prostate cancer is being delivered in Tauranga, the first place in New Zealand to offer the procedure, which could offer hope for patients with cancer that was previously difficult to cure, says a local expert.
Tauranga-based urologist Mark Fraundorfer performed the first ever prostate surgery using the "NanoKnife" technique in November, with five more surgeries completed this week in Tauranga's Grace Hospital on patients from all around the country.
It's cutting edge science, but the NanoKnife procedure involves no cuts or incisions, but rather uses small needle-like probes to deliver 1500 volts of electric current to kill the cancer cells.
Because it preserves the prostate gland, the procedure has less risk of complications of previous prostate surgery or radiotherapy, such as erectile dysfunction or incontinence says Fraundorfer.
"Previously patients with recurring cancers that have been difficult to treat or had a failed treatment, have been given radiotherapy, which heats up the tumour and 'cooks' it until the cancer cells die, but is less effective, and it can be risky as it can damage surrounding areas."
The Nanoknife method is very precise making it suitable for hard to reach areas such as the prostate,
"The accuracy of delivery means it minimises risk to other organs or blood vessels. It is very site-specific using small needles which deliver the current into the tumour. We line it up precisely using an MRI, so you are certain you are navigating to the exact target. The pulses are delivered directly to open "pores" in the cancerous cell membranes causing them irreversible damage."
The Nanoknife system has been used in the US, parts of Europe for pancreatic and liver cancers and was pioneered in Australia last year for prostate cancer by Professor Stricker at St Vincent's Hospital in Sydney.
Until now it had never been used in New Zealand to treat prostate cancer,
Aucklander Kevin Brailey jumped at the chance to be the first New Zealander to undergo the procedure.
Kevin Brailey pictured at his home in Auckland was the first New Zealander to undergo the Nanoknife procedure
Brailey, a businessman in his early 60s, said he had "no qualms" about being the very first, having tried other methods of treatment since he was first diagnosed with prostate cancer in 2012.
"At first there were a few raised eyebrows that it was in Tauranga, but I assured people it is not a fishing village. On the contrary, when I looked into it, the town is the place to be if you have any type of prostate trouble."
Brailey's Auckland doctors had already tried brachytherapy - in which radioactive pellets are delivered through a catheter. But in the two years following treatment blood tests revealed the cancer had not gone away, and the father of five and grandfather of 10 said he faced a life ahead of uncertainty about when not if the cancer would take his life early,
"They didn't spell it out in terms of years but I knew, it is not a good thing to have around and the fact it was not going away was not good news. For the past years my life had been consumed by blood tests and scans, and it was hard on my family. So when I was offered a treatment to potentially cure the cancer, it was something I was completely comfortable with trying. My wife Sue and I met Mark in Tauranga and he spent almost an hour talking to us about prostate cancer -which was the most time anyone has ever given us...it was really clear not only he knew his stuff but he has a real passion about it. And that passion is about saving people's lives."
This love of prostate surgery is apparent meeting Fraundorfer in his rooms in Tauranga which have the feel of an English reception room with paintings of birds on the wall and soft furnishings.
A wooden cabinet displays a selection of tools that used to be used on the prostate -some of which look rather alarming,
"Yes some of the old methods - there is no other way of saying it but going up the arse -were very crude, painful and had risk of infection. Even when those methods were altered and surgery went in via the perenium, because you were attacking the whole prostate, the surgery -even if successful, would often come at the cost of the patient's continence or erectile function."
Neither of these undesirable side-effects occur with the NanoKnife method. Other benefits of the treatment is that it only lasts one hour, and only requires one night stay in hospital with minimal pain afterwards. The "dead" tumour passes out naturally in the patient's lymphatic system meaning there is no incision or scarring.
"I was up and about playing golf and walking just a day after surgery."
Brailey says he feels confident that it has been successful but will know for certain after an MRI in six months and a biopsy in 12 months. He says he feels lucky not only to have been able to try the new treatment but also that his cancer was caught early, as he had no symptoms and at 60 at diagnosis was relatively young,
"In 2012 I had gone to the doctor just with a cold but as it was prostate awareness month the GP was doing checks and that was how it was found. Otherwise I doubt I would even know now as to this day I have had no symptoms."
Tauranga surgeon Mark Fraundorfer shows the selection of instruments which have previously been used to treat prostate cancer
Brailey said the experience had made him want to encourage others to get checks,
"I guess it is the Kiwi male stoical way not to talk about these things but when you think about it, if it is going to save your life then you should talk about it."
He said more awareness would mean men felt more confident in insisting on checks as well as lobbying for groundbreaking treatment such as the nanoknife which was currently only available privately.
Fraundorfer this month completed his 1000th brachytherapy procedure at Grace Hospital, and is hopeful that this and the newer NanoKnife procedure would be considered to be rolled out in the public system.
"NanoKnife is actually very cost effective, gives men a better quality of life afterwards given it minimises those nasty side effects, and at the end of the day is saving lives."
WHAT IS NANOKNIFE?
-NanoKnife provides a minimally invasive option for patients with inoperable or difficult-to-reach tumours, including tumours located near critical structures and major blood vessels in the body.
-Instead of using extreme heat or cold, which could damage normal adjacent tissues, the NanoKnife uses electrical currents to destroy cancerous tumours.
-While the patient is under general anesthesia, the surgeon guides up to six thin needles (electrodes) into the patient's body and strategically places them around the tumour. Then, the NanoKnife sends electrical pulses between each set of needles to puncture permanent nanometer-sized holes into the tumour. This process, called irreversible electroporation (IRE), triggers a cell "suicide," destroying the tumour.
Potential benefits of NanoKnife include: No incisions Less damage to healthy tissue Minimal pain Fewer side effects Short hospital stay Quick recovery Ability to repeat the procedure if new tumours develop
ABOUT PROSTATE CANCER
Prostate cancer is the most commonly diagnosed cancer in men.
Around 1 in 10 New Zealand men will develop prostate cancer at some stage in their lifetime.
Each year in New Zealand approximately 3000 men are diagnosed with prostate cancer and approximately 600 men die from the disease
80 per cent of diagnoses are for men aged 60 years or more.
About 73 per cent more Maori men will die from prostate cancer than Europeans.
The incidence of prostate cancer in New Zealand appears to be increasing.
Source Ministry of Health, Southern Cross, prostate.org.nz
TAURANGA LEADING WORLD IN PROSTATE TREATMENTS Tauranga is the only place to offer all current prostate Cancer treatments other than HIFU (High Intensity Focussed Ultrasound), ie
•Robotically assisted laparoscopic radical prostatectomy (Grace Hospital) •Open radical prostatectomy (Grace and TPH) •External beam radiotherapy (Kathleen Kilgour Centre, public and private) •High Dose Rate brachytherapy (KKC) •Permanent seed or LDR brachytherapy (Grace) •Cryotherapy (freezing) (Grace) •Irreversable Electroporation - Nanoknife (Grace)
