Te Puke man Steve Learmonth was diagnosed with prostate cancer earlier this year and wants to get the nanoknife procedure - but he cannot get it done in New Zealand as a primary option. Photo / Alex Cairns
Te Puke man Steve Learmonth was diagnosed with prostate cancer earlier this year and wants to get the nanoknife procedure - but he cannot get it done in New Zealand as a primary option. Photo / Alex Cairns
A Bay of Plenty prostate cancer patient plans to go to Australia for a $30,000 treatment that could “limit” the risk of side effects such as incontinence and erectile dysfunction after being denied the option of having it in New Zealand.
Steve Learmonth, 66, was diagnosed with prostate cancer this year.
He said he was told his treatment options were having a prostatectomy or radiation. Both had potential side effects of incontinence and erectile dysfunction.
However, upon inquiring about the procedure at Grace Hospital, he said he was told he could not have it as a primary treatment.
Te Puke man Steve Learmonth was diagnosed with prostate cancer earlier this year and wants to get the nanoknife procedure - but he cannot get it done in New Zealand. Photo / Alex Cairns
Grace Hospital said the nanoknife procedure could only be performed as a “salvage procedure” after an initial treatment failed and for patients wanting it first, the best option was Australia.
Prostate cancer patient willing to pay $30,000 for procedure
Learmonth said he was diagnosed with “low-grade” prostate cancer.
He hoped to “limit” the possibility of side effects and inquired with Fraundorfer’s office about the nanoknife procedure as his primary treatment option.
However, “Grace Hospital will not let them use nanoknife technology straight up – it has to be a secondary application so you have to have had radiation treatment first.”
Learmonth said he understood it would cost about $30,000 to have the surgery at Grace Hospital, which he was willing to pay.
Steve Learmonth is willing to pay about $30,000 to get the “non-invasive” procedure done. Photo / Alex Cairns
He said patients could have the nanoknife procedure as their primary treatment option in Australia. He was waiting for an appointment with Fraundorfer to assess whether he was a suitable candidate.
If he was, and upon Fraundorfer’s referral, he planned to have the procedure at St Vincent’s Hospital in Sydney.
In his view, other primary treatment options offered in New Zealand were “archaic” and “very invasive”, and he questioned why nanoknife was only available as a salvage option.
Steve Learmonth is planning to go to Australia to get the nanoknife procedure. Photo / Alex Cairns
Grace Hospital responds
The Bay of Plenty Times put Learmonth’s concerns to Grace Hospital and asked why the nanoknife procedure was not offered as a first option for treatment.
Grace Hospital general manager Janet Keys said the procedure was only available as a “salvage procedure” after the failure of initial treatment to control the cancer – not as a primary treatment. It had one surgeon permitted to do the procedure.
Keys said the treatment was available in Australia and this was the best option for people who could travel.
“I don’t believe that the treatment as a primary procedure is available yet in New Zealand.”
Keys referred to information on the Prostate Cancer Foundation website that said many men with low-grade prostate cancer could be monitored by “active surveillance”.
This involved regular PSA tests, digital rectal examinations, biopsies and imaging scans. If the disease appeared to be changing, a radical treatment aimed at curing the cancer would be offered, such as surgery or radiation therapy, the website said.
The foundation’s website said nanoknife was one of several “focal therapy” techniques being trialled. It believed focal therapy was “currently an experimental approach which aims to destroy areas of cancer within the prostate using minimally invasive techniques to reduce side effects”.
Prostate Cancer Foundation responds
Prostate Cancer Foundation chief executive Peter Dickens said the use of focal therapy such as nanoknife had “continued to be developed around the world” since the information on its website was originally published.
Dickens said it was a “steadily changing and developing area of treatment” for prostate cancer and research on various forms of focal therapy, including nanoknife, continued to be carried out and be published.
He said the National Institute for Health and Care Excellence (Nice) in the United Kingdom - which suggests which treatments should be available for free on the National Health Service (NHS) - announced this year that men could be offered NanoKnife procedures under “special arrangements”.
“This means that Nice feels there are still some uncertainties about long-term safety and efficacy, but that if a patient is informed fully of these and the consultants carrying it out proceed carefully, it can go ahead.”
Dickens said many men reported “excellent results” with focal therapy techniques.
“We are learning more about focal therapy techniques all the time.”
He said focal therapy was not widely available in New Zealand and was only offered “in a limited fashion in private practice”.
Nanoknife procedure ‘extremely low risk’ for side effects
Fraundorfer said the nanoknife procedure was “extremely low risk” for side effects compared to radiation and prostatectomy, which could result in erectile dysfunction, incontinence, and injury to the rectum or bowel.
This was because the urethra, blood vessels and rectum were protected by a layer within their lining when the procedure was performed, he explained.
“For someone who’s wanting to preserve their erections, their ejaculatory function, continence and they’ve got a focal cancer – it’s in one spot – I believe it’s the way of the future for primary focal treatment.”
Tauranga-based urologist Mark Fraundorfer pictured in 2016. Photo / John Borren
Fraundorfer explained the nanoknife procedure involved electrodes being placed around the tumour which delivered a series of “nanosecond pulses” of “very high voltage”.
This punched holes in the cell membrane so the cell died in a “natural” way, he said.
“All other treatments involve removing, freezing or radiating the whole gland which damages tissues all around it.”
Fraundorfer said the nanoknife procedure was not available in the public health system and cost $30,000 to $35,000. He performs the procedure at Grace Hospital as a secondary treatment.
For patients who wanted nanoknife as a primary treatment, Fraundorfer said he assessed patients and, if they were suitable, referred them to Professor Phillip Stricker at St Vincent’s Hospital in Sydney.
“That’s where it’s ideal. As a salvage for radiation, the success rate isn’t as good. As a primary treatment, the success rate is very good.”
He said the cost for the procedure was about the same in Australia as in New Zealand.
Fraundorfer said using the word “experimental” to describe nanoknife, as the Prostate Cancer Foundation’s website has, was in his opinion “a bit misleading”.
He believed a better way to describe it was “investigational”. He also said nanoknife was “a well-established technique”.
Fraundorfer said nanoknife was offered in the UK’s NHS.
He said every patient he had done the nanoknife procedure on had sought him out and “not the other way around”.
”They’re very well read, they’re well-educated and they’ve done their homework and sort of by definition, they know it’s a new technique.”
600-plus procedures done under Australian pioneer’s tutelage
Stricker, who pioneered the nanoknife procedure in Australia, told the Bay of Plenty Times he was treating New Zealanders who wanted it as a primary treatment at St Vincent’s Hospital.
Stricker said more than 600 people had undergone the procedure under his tutelage at the hospital since 2013. This included people who were treated in trials and outside of trials.
He said the 10-year results were published in Britain and found it achieved a 97 per cent clearance of the cancer.
Stricker said it was an “appropriate treatment” for people aged over 55 or 60 with an “intermediate grade” but “quite localised” prostate cancer who rejected radiation and prostatectomy options due to side effects.
It was “very attractive” for people with the “right type of tumour”.
