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Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Type Journal
ISBN 1476-5608 (Electronic) 1365-7852 (Linking)
Authors Ting, F.; Tran, M.; Bohm, M.; Siriwardana, A.; Van Leeuwen, P. J.; Haynes, A. M.; Delprado, W.; Shnier, R.; Stricker, P. D.;
Publisher Name PROSTATE CANCER PROSTATIC DIS
Published Date 2016-01-01 00:00:00
Published Volume 19
Published Issue 1
Published Pages 46-52
URL http://www.ncbi.nlm.nih.gov/pubmed/26458959
Status Published In-print
OpenAccess Link https://publications.gimr.garvan.org.au/download.php?13869_13702/2016-Ting-Prostate Cancer Prostatic Dis.pdf