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Median 5-Year Outcomes of Primary Focal IRE for Localised Prostate Cancer
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As focal therapy continues to grow in popularity, reports with longer-term follow-up periods remain limited. Irreversible electroporation (IRE) uses high-voltage electrical currents to cause tumor cell death. This study evaluated the oncological and functional outcomes of focal IRE in 229 patients with localised prostate cancer (PCa; 86% of the patients had intermediate-risk PCa) during a median follow-up period of 5 years. Although follow-up biopsy showed clinically significant residual PCa in 24% of the patients, post-treatment MRI showed complete ablation in 82%. Although cancer-specific and overall survival remained 100%, 17% of the patients required radical treatment. Urinary continence was preserved in 98% of the patients, but erectile function declined by 13%.
- This study with a longer-term follow-up of patients treated with IRE focal therapy found good quality-of-life outcomes, with oncologic results comparable to those associated with other focal therapies.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVES
To evaluate longer-term oncological and functional outcomes of focal IRE as primary treatment for localised clinically significant prostate cancer (csPCa) at a median follow-up of 5 years (up to 10 years).
MATERIALS AND METHODS
All patients that underwent focal IRE as primary treatment for localised PCa between February 2013 - August 2021 with a minimum 12 months follow-up available were analysed. Follow-up included 6-month MRI and standardized transperineal saturation template +/- targeted biopsies at 12 months, and further biopsies in the case of clinical suspicion on serial imaging and/or prostate-specific antigen (PSA) levels. Failure-free survival was defined as no progression to radical treatment or nodal/distant disease. Local recurrence was defined as any ISUP score ≥ 2 on biopsy.
RESULTS
A total of 229 patients were analysed with a median follow-up of 60 months (IQR 40-80 months). Median age was 68 (IQR 64-74), median PSA was 5.9 ng/mL (IQR 4.1-8.2) and 86% harboured intermediate-risk disease and 7% high-risk disease. Thirty-eight patients progressed to radical treatment (17%) at a median of 35 months post-IRE (17-53). Kaplan-Meier failure-free survival rates were 91% at 3 years, 84% at 5 years and 69% at 8 years. Metastasis-free survival was 99.6% (228/229), PCa-specific and overall survival were 100% (229/229). Residual csPCa was found in 24% (45/190) during follow-up biopsy, MRI showed a complete ablation in 82% (186/226). Short-term urinary continence was preserved (98%, n=3/144 at baseline, 99%, n=1/131 at 12 months) and erections sufficient for intercourse decreased by 13% compared to baseline (71% to 58%).
CONCLUSION
Longer-term follow-up confirms our earlier findings that focal IRE provides acceptable local and distant oncological control in selected men with less urinary and sexual toxicity than radical treatment. Long-term follow-up and external validation of these findings, is required to establish this new treatment paradigm as a valid treatment option.
Additional Info
Disclosure statements are available on the authors' profiles:
Median 5-year outcomes of primary focal irreversible electroporation for localized prostate cancer
BJU Int 2022 Dec 10;[EPub Ahead of Print], MJ Scheltema, B Geboers, A Blazevski, P Doan, A Katelaris, S Agrawal, D Barreto, R Shnier, W Delprado, JE Thompson, PD StrickerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.