For patients with prostate cancer near the urethra, treatment has long meant a difficult trade-off: address the cancer or protect urinary and sexual function. Now, there's a path that works toward both.
NanoKnife irreversible electroporation, or IRE, is available in the Wilmington area through Novant Health - giving physicians a precise, nonthermal option for carefully selected prostate cancer patients. Dr. Anshu Guleria, a board-certified urologist at Novant Health Urology in Wilmington, is performing these procedures and currently treats a few patients each month using this technique.
Why urethra-sparing matters
When a prostate tumor sits adjacent to the urethra, thermal ablation methods like microwave or radio-frequency ablation carry a real risk of urethral sloughing, stricture and long-term urinary complications. NanoKnife IRE takes a different approach entirely.
Rather than using heat, IRE delivers short electrical pulses through thin probes placed at or near the tumor. Those pulses disrupt cancer cell membranes beyond repair, destroying targeted cells while leaving surrounding structures - including the urethra, nerves and blood vessels - largely intact.
Dr. Michelle Fillion, a complex general surgical oncologist at Novant Health who has used NanoKnife IRE in her own practice, describes the mechanism clearly: "When these electrical pulses shoot together, they disrupt the cell's membrane to the point where we're literally just shooting holes in the cell's membrane so that it can't regulate ionic movement and those cells end up dying. Those vital tissues do get spared - that's where it really comes into a benefit."
That tissue selectivity is the key clinical advantage for prostate cases near critical anatomy. It's also why Dr. Guleria has made IRE a part of his regular practice for the right prostate cancer patients in the coastal region.
Referral considerations
A multidisciplinary team evaluates candidates through imaging and clinical review before proceeding. Consider a referral when your patient has:
- Localized prostate cancer with a tumor visible on MRI
- A lesion adjacent to the urethra, where thermal methods pose unacceptable risk
- An interest in preserving urinary and sexual function
- Goals that include avoiding or delaying radical prostatectomy or radiation
IRE can also serve as a complement to surgery. Dr. Fillion, who uses IRE for pancreatic and liver cancers, emphasizes the real-time flexibility the technology offers: "If we need to pivot real-time - say, we're in the operating room, we've planned a resection and if we can't go forward with it - we have an option to real-time pivot and still get the cancer treated on the table without having to have the patient come back or be referred out of the area."
Procedure and follow-up
NanoKnife IRE is performed under general anesthesia, typically as an outpatient procedure. Probes are placed under ultrasound or CT guidance. Percutaneous treatment may be an option for nonsurgical candidates. The procedure can be repeated if clinically indicated and does not preclude future treatment options.
The Novant Health team uses a multidisciplinary approach to determine treatment sequencing, so your patient's full clinical picture is reviewed before a plan is finalized.
"Our goal is to get them back in good functional status so they can get back to enjoying their lives," Dr. Guleria said.
Refer to our coastal team
When NanoKnife IRE may be right for your patient, early referral gives the team time to confirm candidacy and build a personalized plan.
To refer a patient to Novant Health Urology, call 910-662-8765 or visit NovantHealth.org.
NanoKnife IRE has FDA clearance for use in the prostate. Treatment suitability is determined through full clinical evaluation. Individual outcomes vary.
