Focal Irreversible Electroporation for Localized Prostate Cancer – Oncological and Safety Outcomes Using mpMRI and Transperineal Biopsy Follow-Up

Abstract

Introduction: Irreversible electroporation (IRE) technology for prostate cancer (PC) generates consecutive electrical pulses between pairs of electrodes which move through tumorous cells, irreversibly perforate their membranes and eventually lead to cell death, while avoiding tissue thermal effect. The technique is used for primary focal lesions as well as for focal salvage cases. This series reports short term oncological control, quality of life and safety results. Methods: Retrospective data were collected from 45 consecutive cases of primary (N=38) and salvage (N=7) PC patients treated with IRE. All patients had transperineal MRI/US fusion biopsy and PET-PSMA scan prior to treatment, to verify single lesion. Transperineal Nano-Knife IRE system was used in day-care theatre. Patients had 6 months mpMRI, blood PSA and 1 year confirmatory biopsy following procedure. Quality of life was recorded during the first year. Results: Median primary subgroup analysis (N=38): age 69 years, initial PSA 5.6 ng/dL, lesion size 0.8 mL and ISUP Group 2 (1–3). Median salvage subgroup analysis (N=7): age 76 years, initial PSA 11.9 ng/dL, lesion size 2.0 mL and ISUP Group 4 (1–5). Median catheter time 5 (3–7) days. No Clavien–Dindo>1 complications were reported nor re-admissions, incontinence, strictures or fistulas. 5% of patients were given PDE-5i drugs. Primary group PSA dropped by 39%, mpMRI clearance in 84%, out-field new lesion in 12%, in-field lesion in 4%. Biopsy at 1 year: 4 patients had out-field clinically significant PC, thus 3 had re-IRE and 1 had radiation therapy. Salvage subgroup MRI clearance was 60%, and 52% remained on active surveillance by 1 year. Conclusion: IRE treatment for focal PC is safe for primary and salvage cases, if done by a meticulously skilled and trained team, and under strict protocols. The short term oncological results are promising especially for primary lesions. Long term oncological results will be published over time.