Impact on genitourinary function and quality of life following focal irreversible electroporation of different prostate segments

Scheltema, Matthijs J.; Chang, John; Bos, Willemien van den; Gielchinsky, Ilan; Nguyen, Tuan V.; Reijke, Theo de; Siriwardana, Amila; Böhm, Maret; Rosette, Jean J. de la; Stricker, Phillip D.

doi:10.5152/dir.2018.17374

Cited by 19 publications

(7 citation statements)

References 25 publications

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“…Management of PCa with focal therapy aims to minimise the quality of life complications while simultaneously decreasing the risk of PCa progression. The initial focal therapy programs have concentrated on management of low and intermediate risk PCa, as this cohort has a low probability of PCa specific mortality within a decade of diagnosis, even when treated with an initial approach of active surveillance [ 1 2 3 ].…”

Section: Introductionmentioning

confidence: 99%

Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study

et al. 2022

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Purpose Focal irreversible electroporation (IRE) for prostate cancer aims to reduce quality of life complications, however outcomes data remains limited. We aimed to evaluate histological in-field clearance of prostate cancer at ≥12 months post-IRE. Materials and Methods Retrospective review of prospectively acquired data of consecutive patients treated between August 2018 and August 2021. Significant recurrence was defined as a ≥6 mm core Gleason 3+3, or ≥Gleason 3+4 with ≥4 mm tumour length. A second definition of any focus of International Society of Urological Pathology (ISUP) ≥2 was also analysed. Results The median follow-up of the entire cohort is 23 months (range 3–39 mo). For 64 primary IRE procedures, surveillance biopsy was performed in 40/50 (80.0%) with ≥12 months follow-up. Significant in-field recurrence occurred in 3/40 (7.5%), or 4/40 (10.0%) with any focus of ISUP >2. Significant out-of-field recurrence occurred in 5/40 (12.5%). In salvage IRE, three patients (3/6, 50.0%) have undetectable prostate-specific antigen levels, two have no residual cancer on biopsy and one patient had out-of-field recurrence. For sexually active men, erectile function was maintained in 24/28 (85.7%) of primary IRE. No incontinence developed in primary IRE (0/64). Conclusions Focal primary IRE for prostate cancer is associated with 90% infield ablation of any ISUP grade >2 cancer with a low risk of urinary incontinence or impotence. Surveillance prostate biopsies are required to exclude progression despite a normal post-IRE multiparametric magnetic resonance imaging (mpMRI). Salvage IRE is a promising option for localised recurrence after prostate radiotherapy with low morbidity.

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Section: Introductionmentioning

confidence: 99%

Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study

et al. 2022

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“…3,4 Several studies confirmed that connective tissue structure could be preserved and there is minor damage to associated blood vessels, neural tissue, or other vital structures. 5 While the safety and efficacy of IRE in the treatment of prostate cancer has been demonstrated in several studies, 6,7 the adoption of IRE as a valid focal ablative therapy modality has been slow and the lack of comparative randomized controlled trials may be one of the main reasons. In this study, we present the results from a multicenter randomized controlled trial comparing focal and extended IRE ablation therapy for localized prostate cancer patients and report on short-to mid-term results regarding the side effects, quality of life, and oncologic control.…”

Section: Limitationsmentioning

confidence: 99%

A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer

et al. 2023

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Purpose: Our goal was to evaluate the effect of focal vs extended irreversible electroporation on side effects, patient-reported quality of life, and early oncologic control for localized low-intermediate risk prostate cancer patients. Materials and Methods: Men with localized low-intermediate risk prostate cancer were randomized to receive focal or extended irreversible electroporation ablation. Quality of life was measured by International Index of Erectile Function, Expanded Prostate Cancer Index Composite questionnaire, and International Prostate Symptom Score. Results: A total of 51 and 55 patients underwent focal and extended irreversible electroporation, respectively. The median follow-up time was 30 months. Rates of erectile dysfunction and rates of adverse events were similar between the 2 groups at 3 months. The focal ablation group seemed to have better International Index of Erectile Function scores at 3 months; it also had a better Expanded Prostate Cancer Index Composite-sexual function score than the extended ablation group across time that was close to statistical significance (mean difference 1.4; 95% CI À0.13 to 2.9, P [ .073). There were no significant differences between the 2 groups in other quality-of-life measures. Upon prostate biopsy at 6 months, the rate of residual clinically significant prostate cancer (Gleason !3 D 4) was 18.8% and 13.2% in the focal and extended irreversible electroporation groups, respectively, without significant differences. Conclusions: Focal and extended irreversible electroporation ablation had similar safety profile, urinary function, and oncologic outcomes in men with localized low-intermediate risk prostate cancer. In addition, focal ablation demonstrated superior erectile function outcome over extended irreversible electroporation in the first 3-6 months.

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“…However, it is important to point out that the numbers in this cohort are very low and no conclusion can be made from this analysis. It has previously been shown that there is no correlation between prostate segment treatment with IRE and erectile dysfunction or continence [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Salvage robot-assisted radical prostatectomy following focal ablation with irreversible electroporation: feasibility, oncological and functional outcomes

et al. 2022

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Background To report the feasibility, oncological and functional outcomes of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer (PCa) after irreversible electroporation (IRE). Methods This was a retrospective analysis of patients who underwent sRARP by a single high-volume surgeon after IRE treatment in our institution. Surgical complications, oncological and functional outcomes were assessed. Results 15 patients with at least 12 months follow up were identified out of the 234 men who underwent primary IRE between 2013 and 2019. The median [IQR] age was 68 (62–70) years. The median [IQR] time from focal IRE to sRARP was 42 (21–57) months. There were no rectal, bladder or ureteric injuries. The T-stage was pT2 in 9 (60%) patients and pT3a in 6 (40%) patients. Only one (7%) patient had a positive surgical margin. At a median [IQR] follow up of 22 (16–32) months no patient had a biochemical recurrence (PSA > 0.2). All 15 patients were continent (pad-free) by 6 months and 9 (60%) patients had erections sufficient for intercourse with or without PDE5 inhibitors. No predisposing factors were identified for predicting erectile dysfunction after sRARP. Conclusions In patients with recurrent or residual significant PCa after focal IRE ablation it is feasible to obtain good functional and oncological outcomes with sRARP. Our results demonstrate that good outcomes can be achieved with sRARP, when respecting close monitoring post-IRE, good patient selection and surgical experience. The limitations of this study are that it is a small series, with short follow up and a lack of standardised quality of life instruments.

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Impact on genitourinary function and quality of life following focal irreversible electroporation of different prostate segments

Cited by 19 publications

References 25 publications

Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study

Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study

A Multicenter, Randomized, Single-blind, 2-Arm Intervention Study Evaluating the Adverse Events and Quality of Life After Irreversible Electroporation for the Ablation of Localized Low-intermediate Risk Prostate Cancer

Salvage robot-assisted radical prostatectomy following focal ablation with irreversible electroporation: feasibility, oncological and functional outcomes

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