Focal ablation of apical prostate cancer lesions with irreversible electroporation (IRE)

Abstract

Introduction and objective

To assess the safety, oncological and quality-of-life (QoL) outcomes of focal ablation of apical prostate cancer (PCa) lesions with irreversible electroporation (IRE).

Methods

Patients were included in the study if they had a PCa lesion within 3 mm of the apical capsule treated with IRE. The IRE procedure was performed in our institution by a single urologist. The QoL and functional data was collected prospectively from patients who provided consent using the Expanded Prostate Cancer Index Composite (EPIC). Oncological follow up included 3-month PSA levels, mpMRI at 6 months and transperineal biopsy at 1-year post treatment.

Results

A total of 50 patients had apical PCa lesions treated between February 2013 and September 2018. Median follow-up was 44 months. There were no Clavien–Dindo grade 3 events or higher. No perioperative complications were recorded. No significant difference was observed in the EPIC urinary or bowel QoL domain between baseline and 12-month post-treatment. One patient (2%) required one pad per day for urinary incontinence 12-month post-treatment. There was a small but significant decline in EPIC sexual QoL (65 at baseline and 59 at 12-month post-IRE). Of patient’s potent pre-treatment, 94% remained potent after treatment. The median PSA nadir decreased by 71% (6.25–1.7 ng/mL). Only one patient (2.5%) had in-field residual disease on repeat biopsy.

Conclusion

Focal ablation using IRE for PCa in the distal apex appears safe and feasible with acceptable early QoL and oncologic outcomes.

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Funding

Funding was provided by Australian Prostate Cancer Research Centre-NSW and St. Vincent’s Prostate Cancer Centre.

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Authors

Contributions

AB: project development, data collection, manuscript writing/editing, data analysis. AA: manuscript writing/editing, data analysis. MS: project development, manuscript writing/editing, data analysis. AB: data collection. A-MH: data collection, ethics. DB: data collection. TC: data collection, ethics. JT: manuscript writing/editing. PS: project development, manuscript writing/editing.

Corresponding author

Correspondence to Alexandar Blazevski.

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Conflict of interest

Prof. Phillip Stricker is a paid consultant to Angiodynamics. Dr. Alexandar Blazevski is a paid proctor to Getz Healthcare. All other authors have nothing to disclose.

Ethics approval/informed consent

The board of the Human Research Ethics Committee of St. Vincent’s Hospital (Sydney, Australia) approval prospective acquisition of patient-reported QoL outcomes (HREC approval SVH 13/018) after institutional review. The analysis and data collection were performed following the Declaration of Helsinki after written informed consent was obtained from all patients.

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Blazevski, A., Amin, A., Scheltema, M.J. et al. Focal ablation of apical prostate cancer lesions with irreversible electroporation (IRE). World J Urol 39, 1107–1114 (2021). https://doi.org/10.1007/s00345-020-03275-z

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Keywords

  • Irreversible electroporation
  • Apex
  • Apical
  • Prostate
  • Prostate cancer
  • Focal therapy