Format

Send to

Choose Destination
BJU Int. 2018 May;121(5):716-724. doi: 10.1111/bju.13983. Epub 2017 Sep 4.

Focal irreversible electroporation as primary treatment for localized prostate cancer.

Author information

1
Garvan Institute of Medical Research and Kinghorn Cancer Centre.
2
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.
3
Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
4
Southern Radiology, Randwick.
5
Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.

Abstract

OBJECTIVES:

To determine the safety, quality of life (QoL) and short-term oncological outcomes of primary focal irreversible electroporation (IRE) for the treatment of localized prostate cancer (PCa), and to identify potential risk factors for oncological failure.

PATIENTS AND METHODS:

Patients who met the consensus guidelines on patient criteria and selection methods for primary focal therapy were eligible for analysis. Focal IRE was performed for organ-confined clinically significant PCa, defined as high-volume disease with Gleason sum score 6 (International Society of Urological Pathology [ISUP] grade 1) or any Gleason sum score of 7 (ISUP grades 2-3). Oncological, adverse event (AE) and QoL outcome data, with a minimum of 6 months' follow-up, were analysed. Patient characteristics and peri-operative treatment variables were compared between patients with and without oncological failure on follow-up biopsy. Wilcoxon's signed rank test, Wilcoxon's rank sum test and the chi-squared test were used to assess statistically significant differences in paired continuous, unpaired continuous and categorical variables respectively.

RESULTS:

A total of 63 patients met all eligibility criteria and were included in the final analysis. No high-grade AEs occurred. QoL questionnaire analysis demonstrated no significant change from baseline in physical (P = 0.81), mental (P = 0.48), bowel (P = 0.25) or urinary QoL domains (P = 0.41 and P = 0.25), but there was a mild decrease in the sexual QoL domain (median score 66 at baseline vs 54 at 6 months; P < 0.001). Compared with baseline, a decline of 70% in prostate-specific antigen level (1.8 ng/mL, interquartile range 0.96-4.8 ng/mL) was seen at 6-12 months. A narrow safety margin (P = 0.047) and system errors (P = 0.010) were identified as potential early risk factors for in-field oncological failure. In-field and whole-gland oncological control on follow-up biopsies was 84% (38/45 patients) and 76% (34/45 patients); this increased to 97% (38/39 patients) and 87% (34/39 patients) when patients treated with a narrow safety margin and system errors were excluded.

CONCLUSION:

Our data support the safety and feasibility of focal IRE as a primary treatment for localized PCa with effective short-term oncological control in carefully selected men.

KEYWORDS:

IRE ; #PCSM; #ProstateCancer; focal therapy; irreversible electroporation; primary treatment; prostate

PMID:
28796935
DOI:
10.1111/bju.13983
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center