Abstract
BackgroundIrreversible Electroporation (IRE) is a novel image-guided tissue ablation technology that induces cell death via very short but strong pulsed electric fields. IRE has been shown to have preserving properties towards vessels and nerves and the extracellular matrix. This makes IRE an ideal candidate to treat prostate cancer (PCa) where other treatment modalities frequently unselectively destroy surrounding structures inducing severe side effects like incontinence or impotence. We report the retrospective assessment of 471 IRE treatments in 429 patients of all grades and stages of PCa with 6-year maximum follow-up time.Material and findingsThe patient cohort consisted of low (25), intermediate (88) and high-risk cancers (312). All had multi-parametric magnetic resonance imaging, and 199 men had additional 3D-mapping biopsy for diagnostic work-up prior to IRE. Patients were treated either focally (123), sub-whole-gland (154), whole-gland (134) or for recurrent disease (63) after previous radical prostatectomy, radiation therapy, etc. Adverse effects were mild (19.7%), moderate (3.7%) and severe (1.4%), never life-threatening. Urinary continence was preserved in all cases. IRE-induced erectile dysfunction persisted in 3% of the evaluated cases 12 months post treatment. Mean transient IIEF-5-Score reduction was 33% within 12-month post IRE follow-up and 15% after 12 months. Recurrences within the follow-up period occurred in 10% of the treated men, 23 in or adjacent to the treatment field and 18 outside the treatment field (residuals). Including residuals for worst case analysis, Kaplan Maier estimation on recurrence rate at 5 years resulted in 5.6% (CI95: 1.8–16.93) for Gleason 6, 14.6% (CI95: 8.8–23.7) for Gleason 7 and 39.5% (CI95: 23.5–61.4) for Gleason 8–10.ConclusionThe results indicate comparable efficacy of IRE to standard radical prostatectomy in terms of 5-year recurrence rates and better preservation of urogenital function, proving the safety and suitability of IRE for PCa treatment. The data also shows that IRE, besides focal therapy of early PCa, can also be used for whole-gland ablations, in patients with recurrent PCa, and as a problem-solver for local tumor control in T4-cancers not amenable to surgery and radiation therapy anymore.
Highlights
The incidence of prostate cancer (PCa) is increasing worldwide, with an estimated 1.1 million new cases in 2012 [1]
Kaplan-Meier-curves presented here further showed a very similar slope as compared to the recently published data on 5-year outcomes of High Intensity Focal Ultrasound (HIFU) treatment for PCa [10], The fact that our Kaplan-Meier-curves presented here further have showed a very similar slopes as compared to the recently published data on 5-year outcomes of HIFU treatment for PCa [10] indicates the higher effectiveness of Irreversible Electroporation (IRE) for PCa treatment compared to HIFU, since the HIFU, even though their patient cohort comprised few high-risk and advanced disease patients, whilst our cohort included many of those. only included very few patients with advanced diseases and/or high Gleason Scores, whereas the results presented here have a high number of patients with high risk disease
The retrospective evaluation of our data allows the conclusion that Irreversible Electroporation (IRE) is a safe, effective and suitable modality for the treatment of PCa at all clinical stages and recurrent disease
Summary
The incidence of prostate cancer (PCa) is increasing worldwide, with an estimated 1.1 million new cases in 2012 [1]. Irreversible Electroporation (IRE), a novel tissue ablation technology, has the advantage of being non-thermal with elements of tissue selectivity [11], which significantly reduces toxicity on vital anatomical structures surrounding the malignancy Because of these properties, IRE might become a standard therapy for PCa, and further, a problem solver for advanced T4-cancers for which there are few other treatment options and/or only treatable with resulting permanent damage. IRE has been shown to have preserving properties towards vessels and nerves and the extracellular matrix This makes IRE an ideal candidate to treat prostate cancer (PCa) where other treatment modalities frequently unselectively destroy surrounding structures inducing severe side effects like incontinence or impotence. We report the retrospective assessment of 471 IRE treatments in 429 patients of all grades and stages of PCa with 6-year maximum follow-up time.
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