Oncological and functional outcomes of focal irreversible electroporation for localised prostate cancer: a single institution series of 171 cases

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Abstract Background Focal irreversible electroporation (IRE) is an attractive choice for patients aiming to obtain local control of prostate cancer, while decreasing the postoperative risk of impotence and incontinence compared to whole-gland treatments. Methods Retrospective review of a single centre prospective database of 171 consecutive primary IRE procedures for localised prostate cancer. Primary outcomes include oncological infield and out-of-field progression. Secondary objectives include post-IRE continence and impotence. Results The median follow-up is 35 months (3–90 months). The median diameter of the treated lesions is 11 mm (4–24 mm). Most patients had PI-RADS 4–5 abnormalities on prostate MRI, and 25 patients (15%) had ISUP grade 4–5 cancer. Of the 135 patients with >12 months follow-up, 84 had a surveillance biopsy of whom 8.3% had significant infield persistence, with significant out-of-field cancer in 14.3%. There was no difference in the risk of infield cancer persistence regardless of the pre-IRE ISUP score ( p = 0.8), or tumour location ( p > 0.9). The presence of low volume out-of-field cancer at diagnosis did not increase the risk of post-IRE cancer persistence/progression ( p = 0.7). The prostate PSMA PET SUVmax of ≥10 did not increase the risk of infield or out-of-field recurrence of cancer ( p = 0.3). A PSAD > 0.15 did not increase the risk of infield persistence or out-of-field progression of cancer ( p = 0.8). Urinary continence was maintained in 167/171 (97.6%), while erectile function was maintained in 94/112 (84%) of sexually active patients who completed questionnaires. Conclusions Of the patients who proceeded to post-IRE biopsy, 92% had infield ablation of clinically significant cancer with a low risk of urinary incontinence or impotence. Focal IRE of prostate cancer has promising short to medium-term outcomes and is associated with low risks of impotence and incontinence. Long-term follow-up of out-of-field progression risk is required.