Current data on the use of irreversible electroporation (IRE) in the treatment of prostate cancer (PCa) is limited. We aim to evaluate the safety, short-term functional and oncological outcomes of focal IRE in low-intermediate risk PCa.
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Between February 2013 and May 2014, 32 consecutive men underwent IRE at a single centre. Patients with low-intermediate risk PCa who had not received previous PCa treatment were included for analysis. The tumour was ablated using 3-6 electrodes, ensuring a minimum 5-mm safety margin around the visible magnetic resonance imaging (MRI) lesion. Follow-up included recording Clavien complications, Expanded Prostate Cancer Index Composite (EPIC) questionnaires (baseline, 1. 5, 3, 6 months), 6-month multi-parametric MRI (mp-MRI) and 7-month biopsy. Findings on mp-MRI and biopsy were sub-divided into infield, adjacent or outfield of the treatment zone.
Twenty-five men were included for final analysis. Safety follow-up revealed one Clavien Grade 3 complication and five Grade 1 complications. Functional follow-up confirmed no significant change in American Urological Association urinary symptom score, sexual or bowel function. Infield, there were no suspicious findings on mp-MRI (n=24) or biopsy (n=21) in all patients. Adjacent to the treatment zone, five (21%) had suspicious findings on mp-MRI with four (19%) proving to be significant on biopsy. Outfield, there were two (8%) with suspicious findings on mp-MRI and one (5%) significant finding on biopsy. For the five patients with significant findings on follow-up biopsy, one is awaiting repeat IRE, one had radical prostatectomy and three remained on active surveillance.
In selected patients with low-intermediate risk PCa, focal IRE appears to be safe with minimal morbidity. There were no infield recurrences and 76% of patients were histologically free of significant cancer at 8 months. Almost all recurrences were adjacent to the treatment zone, and this was addressed by widening the treatment margins. Prostate Cancer and Prostatic Diseases advance online publication, 13 October 2015; doi:10. 1038/pcan. 2015. 47.
Prostate cancer and prostatic diseases. 2015 Oct 13 [Epub ahead of print]
F Ting, M Tran, M Böhm, A Siriwardana, P J Van Leeuwen, A-M Haynes, W Delprado, R Shnier, P D Stricker
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia. , St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia. , Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia. , St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia. , St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia. , Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia. , Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia. , Southern Radiology, Randwick, NSW, Australia. , St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.