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Oncology · UK specialist centres

NanoKnife (IRE) focal therapy, the non-thermal option for tumours near what matters.

Irreversible electroporation for localised prostate cancer (NICE IPG683), locally advanced pancreatic cancer (NICE IPG548) and selected liver tumours - at the small group of UK centres that do it properly, with honest alternatives on the table.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private NanoKnife (IRE) costs in the UK.

Indicative ranges across UK specialist centres.

In short

Prostate focal IRE privately: £15,000–£25,000, home day-case or next morning.

Procedure Indicative range
Prostate IRE (private, UK) £15,000–£25,000
Pancreatic IRE (private, UK) £30,000–£50,000
Liver IRE (selected cases) £18,000–£35,000
Multiparametric prostate MRI £450–£900
Transperineal template biopsy £2,500–£4,500
Consultation with specialist urologist or HPB surgeon £300–£500

Prices vary by centre, by which consultant leads the case, by anaesthetic time and by whether workup imaging and biopsy are included in the package. NHS access via NICE IPG683 or IPG548 pathways is possible at approved specialist centres.

The problem

The right centre, the right patient, the right technique.

NanoKnife is powerful and specific. It is also easy to mis-book - offered to the wrong patient, at a centre that does two cases a year, without an honest discussion of surgery, radiotherapy or HIFU. We fix all three before you commit.

  • Is IRE actually right for you?

    Low- or intermediate-risk localised prostate cancer, LAPC alongside chemotherapy, or a specific liver lesion. We say honestly when it is not.

  • Volume matters, a lot

    You want a centre that has done hundreds, not tens. We route you to UK teams doing this weekly, not annually.

  • Alternatives on the table

    Active surveillance, radical prostatectomy, radiotherapy, brachytherapy, HIFU, cryotherapy, chemotherapy - discussed before you agree.

When it helps

When NanoKnife (IRE) is the right step.

The situations UK MDTs actually offer IRE for, plus the one red flag that tells you it is the wrong technique.

  • Localised prostate cancer

    Low or intermediate-risk disease on an MRI-visible lesion - an alternative to active surveillance, surgery, radiotherapy or HIFU (NICE IPG683).

  • Locally advanced pancreatic cancer

    Stage III pancreatic cancer encasing vessels and not resectable - IRE alongside chemotherapy at select UK centres (NICE IPG548).

  • Liver tumours near vessels or ducts

    HCC or colorectal metastasis sitting close to bile ducts or major vessels where thermal ablation would cause injury.

  • Nerve-sparing prostate ablation

    Where preserving erectile nerves and the urinary sphincter matters and thermal ablation is felt to be too risky.

  • Local recurrence after radiotherapy

    Selected radio-recurrent prostate cancer where salvage surgery is high-risk - focal IRE is discussed at MDT.

  • Renal tumours (investigational)

    Small renal masses in unusual positions - still investigational and only in trials or specialist centres.

  • When thermal ablation is unsuitable

    Heat-sink effect near large vessels, or proximity to bile ducts, urethra or rectum, can make RFA, microwave or HIFU the wrong choice.

  • Red flag: high-risk or metastatic disease

    High-risk localised, node-positive or metastatic prostate cancer is not a NanoKnife problem - it needs radical or systemic treatment.

Procedure options

NanoKnife is not the only option.

What each option on the table actually involves - and which fits which problem.

  • Prostate focal IRE

    TRUS-guided transperineal electrodes around an MRI-visible lesion under GA with paralysis and cardiac gating - 45–90 minutes, day-case.

  • Pancreatic IRE (percutaneous)

    CT-guided percutaneous electrodes into a locally advanced pancreatic tumour - under GA, 2–4 hours, ITU or HDU afterwards.

  • Pancreatic IRE (open or laparoscopic)

    Electrodes placed under direct vision at laparotomy or laparoscopy when the tumour cannot be reached safely percutaneously.

  • Liver IRE

    Percutaneous or open electrode placement for HCC or colorectal liver metastasis near portal structures - a niche indication.

  • HIFU (thermal focal alternative)

    High-intensity focused ultrasound - heat-based focal prostate treatment. Different physics, different side-effect profile.

  • Cryotherapy

    Freeze-based focal ablation for prostate or renal tumours - an older, established thermal option to compare with IRE.

  • Radical prostatectomy or radiotherapy

    The whole-gland benchmarks. Long-term oncological data is strongest here - IRE is an alternative, not yet a replacement.

  • Second opinion only

    Sometimes the answer is that IRE is not right - we are happy to give an honest read on your case without booking anything.

Safety and recovery

What to expect afterwards - honestly.

IRE is a technically demanding procedure with real advantages and real trade-offs. The essentials worth planning: anaesthetic, cardiac gating, the follow-up schedule and knowing which complications are common versus rare.

  • GA with full muscle paralysis

    The high-voltage pulses cause strong muscle contractions. Complete neuromuscular blockade is essential to prevent dangerous body movement during delivery.

  • Cardiac gating is standard

    Pulses are synchronised to the refractory period of the heartbeat via ECG gating to keep the risk of arrhythmia very low.

  • Non-thermal, tissue-selective

    IRE damages cell membranes rather than cooking tissue, so collagen, blood vessels, nerves and bile ducts are largely preserved.

  • Prostate potency and continence

    A key attraction of focal IRE is preservation of erectile nerves and the urinary sphincter compared with radical prostatectomy or radiotherapy.

  • Prostate complications

    Transient urinary retention, UTI, dysuria, haematuria and mild pain are common. Erectile dysfunction and incontinence are low; rectourethral fistula is very rare.

  • Pancreatic complications

    Bleeding, pancreatitis, biliary leak or stricture, and portal vein thrombosis can occur. Arrhythmia is rare with proper cardiac gating.

  • Incomplete ablation and recurrence

    Focal treatment treats the lesion, not the whole gland or organ. In-field or out-of-field recurrence can happen and salvage treatment must remain possible.

  • Long-term data is still maturing

    Five-year prostate outcomes are encouraging; ten-year and cancer-specific survival data are still being collected. Honest to name that up front.

  • Red flags after treatment

    Fever, severe abdominal pain, jaundice, heavy bleeding, inability to pass urine or spreading redness are reasons to contact the team or A&E the same day.

Reading your operation note

Your IRE note in four parts. Read the last one first.

Whichever centre performs the case, the note the team sends you keeps to the same shape.

A UK consultant reviewing a patient’s focal therapy operation notes

A quiet reminder

Ablation language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your follow-up scan or PSA, just ask.

  1. 01 Header

    Diagnosis and treatment intent

    The tumour, stage, biopsy result, and whether IRE is being offered with curative, cytoreductive or palliative intent.

  2. 02 Technique

    Electrodes, energy and gating

    Number of electrodes, spacing, voltage and pulse parameters, image-guidance modality, and confirmation of paralysis and cardiac gating.

  3. 03 Findings

    Ablation zone and adjacent structures

    Coverage of the target lesion, margin achieved, and comments on nearby vessels, nerves, urethra, rectum, bile ducts and pancreas.

  4. 04 Impression

    Follow-up plan and next steps

    Read this first: the imaging and PSA or oncology follow-up schedule, when the next biopsy or scan is due, and what triggers salvage treatment.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for NanoKnife (IRE) varies by insurer and by indication - case-by-case pre-authorisation is normal for focal cancer therapy.

Frequently asked

Everything we get asked about NanoKnife (IRE).

Quick answers on NICE approval, cost, UK centres, outcomes and how it compares with HIFU, surgery and radiotherapy.

  • What is NanoKnife (IRE) and how does it work?

    NanoKnife is the brand name for irreversible electroporation (IRE), a non-thermal focal ablation technique. Short, high-voltage electrical pulses between paired electrodes create permanent nano-scale holes in cell membranes, killing tumour cells while largely sparing collagen, blood vessels, nerves and ducts - which is why it is used near sensitive structures.

  • Is NanoKnife approved by NICE in the UK?

    Yes, with caveats. NICE IPG683 (2021) covers focal IRE for localised prostate cancer, and NICE IPG548 (2015) covers IRE for locally advanced pancreatic cancer. Both are approved with special arrangements for governance, consent and audit, and delivered at a small number of specialist UK centres.

  • Which UK centres offer NanoKnife?

    For prostate IRE, UK centres include UCLH, King’s College Hospital, Bristol, Portsmouth, Nottingham and Guildford. For pancreatic IRE, Liverpool, Bristol and King’s are among the small group of centres offering it.

  • How much does NanoKnife cost privately in the UK?

    Roughly £15,000–£25,000 for prostate focal IRE and £30,000–£50,000 for pancreatic IRE, including anaesthetic, theatre and inpatient stay. Liver IRE typically sits at £18,000–£35,000. NHS access via NICE IPG pathways at specialist centres is also possible.

  • How is NanoKnife different from HIFU, cryotherapy or radiotherapy?

    HIFU (heat) and cryotherapy (freezing) are thermal - they cook or freeze tissue and can damage nearby vessels, nerves and ducts. Radiotherapy uses radiation over weeks. IRE is non-thermal, faster in the treatment window, and preserves the collagen scaffold of nerves and vessels, which is why prostate potency and continence outcomes are strong.

  • Why does NanoKnife need general anaesthetic and cardiac gating?

    The high-voltage pulses cause strong involuntary muscle contractions, so full neuromuscular paralysis under GA is essential to prevent dangerous body movement. The pulses are also synchronised to the refractory period of your heartbeat via ECG gating, which keeps the risk of arrhythmia very low.

  • What are the side effects of prostate NanoKnife?

    Most men experience transient urinary retention, UTI risk, dysuria, blood in the urine, mild pelvic pain and short-lived rectal symptoms. Erectile dysfunction and urinary incontinence rates are low compared with radical surgery or radiotherapy. Rectourethral fistula is very rare. Incomplete ablation or later recurrence is possible and would need repeat or salvage treatment.

  • What are the outcomes and long-term data for prostate NanoKnife?

    Published series report 5-year MRI-negative disease in roughly 60–80% of well-selected low- and intermediate-risk patients, with excellent preservation of potency and continence versus radical prostatectomy or radiotherapy. Ten-year and cancer-specific survival data are still maturing, which is why patient selection and follow-up matter.

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