The treatment of prostate cancer (PCa) requires approaches that eliminate malignant tissue while preserving essential urinary and sexual functions. Irreversible electroporation (IRE) represents a targeted ablative strategy that disrupts cellular membrane integrity through precise electrical pulses, demonstrating the capacity to ablate cancerous foci while sparing adjacent neurovascular bundles and sphincter mechanisms. This structured review examines the mechanistic foundations of IRE technology, evaluates current clinical evidence regarding safety and efficacy, and explores promising applications that may redefine precision urologic care. Existing clinical studies demonstrate encouraging oncological control rates with superior preservation of continence and erectile function compared to whole-gland treatments, though patient selection criteria and long-term durability remain areas requiring further investigation. Emerging applications include salvage therapy following radiation failure, integration with advanced multiparametric imaging for precision targeting, and combination strategies with systemic therapies. The regulatory approval status and economic implications of IRE implementation vary significantly across healthcare systems, creating disparities in patient access and adoption of this technology that must be addressed to ensure equitable availability of focal ablation options. As the technology matures, establishing standardized treatment protocols, refining patient selection algorithms, and conducting robust comparative effectiveness studies will be essential to define the optimal role of IRE within prostate cancer management.
Prostate international. 2025 Nov 07 [Epub]
Francisco O Durazo-Ruiz, Rocío Roldán-Testillano, Lara Rodriguez-Sanchez, M Pilar Laguna, Liam N Mendez-Bisgaard, Adel Arezki, Hussein Elkhatib, Alejandro Hevia-Feliu, Kai Zhang, Jonathan Fainberg, Nathan Perlis, Jean de la Rosette, Bernardino Miñana-López, Theo M de Reijke, Maurice Anidjar, Mark Emberton, Phillip D Stricker, Rafael Sanchez-Salas
Department of Urology, McGill University Health Centre, Montréal, Canada., Department of Urology, Institut Mutualiste Montsouris, Paris, France., International School of Medicine, Istanbul Medipol University, Istanbul, Türkiye., School of Medicine and Health Sciences of Tecnológico de Monterrey, Guadalajara, Mexico., Department of Urology, Northern Ontario School of Medicine University, Thunder Bay, Canada., Hospital Universitario Infanta Sofía, Madrid, Spain., Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Bashkir State Medical University, Ufa, Russia., Urology Department, CUN Prostate Center, Clínica Universidad de Navarra, Madrid, Spain., Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Division of Surgery & Interventional Science, University College London, Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, St Vincent's Hospital and Private Clinic, Darlinghurst, NSW, Australia.