Irreversible electroporation in treatment of prostate cancer

Abstract

Irreversible electroporation (IRE), since its first introduction into the medical field in 2005, is gaining importance as a tissue ablation method. Being basically nonthermal, IRE destroys cells while preserving tissue infrastructure, i.e., all noncellular tissue elements. This property accounts for IRE's low toxicity to healthy tissues: Structures such as vessels, ducts, nerves, hollow viscera, and others with a well-defined fibrous scaffold are preserved or regenerate quickly by regrowth of healthy cells along the organ's scaffold. This makes IRE an ideal tissue ablation modality for prostate cancer (PCa). The prostate is surrounded by vital anatomical structures such as nerves, vessels, sphincters, the urinary bladder, and the rectum, which are regularly damaged by established PCa therapies such as surgery and radiation therapy, but also by other - thermal - tissue ablation methods such as high-energy focused ultrasound (HiFU). This collateral damage leads to impotence and incontinence in an unacceptable percentage of the treated men while providing only a small survival benefit compared to untreated men, rendering established therapies for PCa sadly inadequate. In view of the fact that PCa is the second most common cancer in men worldwide, the arrival of IRE has long been awaited and holds the potential to change the way PCa is dealt with - and the fate of the men affected by it. Because of the rising importance of IRE for the treatment of PCa, this chapter provides an overview of the most important biophysical, technical, and clinical aspects of IRE for this specific application and a summary of the published data to date.