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Personalized Treatment Strategy in "Low-Risk Prostate Cancer Active Surveillance Candidates" Using Irreversible
Ionel Valentin Popeneciu1,2, Mirjam Naomi Mohr1, Arne Strauß1
1Department of Urology, University Medical Center Goettingen, Goettigen, Germany.
Purpose:
To evaluate the morbidity, functional and oncological outcome of irreversible electroporation (IRE) as a focal therapy for prostate cancer (PCa) when used in "active surveillance (AS)" candidates refusing standard treatment options.
Materials And Methods:
IRE was performed under general anaesthesia, and the transurethral catheter was removed one day after intervention in all patients. Pre- and post-interventional voiding parameters (measured by International Prostate Symptom Score Questionnaire [IPSS], uroflowmetry and post-void residue) were compared. Follow-up (FU) was observed over a minimum of six months, including oncological outcome (controlled by multiparametric magnetic resonance imaging, rebiopsy, prostate-specific antigen dynamic as well as the need and type of secondary treatment) and general functional outcome (International Index of Erectile Function Questionnaire, satisfaction of the procedure).
Results:
Twenty-four patients refusing AS or standard treatment with a median FU of 18.7 months were included. IPSS showed nine patients with mild, 12 with moderate and two with severe obstructive voiding symptoms pre-intervention (focal IRE). Median IPSS pre-IRE was 9 points, 8.5 (p=0.341) at six months and 10 (p=0.392) after 12 months, respectively. Pre-IRE maximum urinary flow (Qmax) (median: 16.1±8.0 mL/sec) and Qmax after catheter removal (16.2±7.6 mL/sec) did not differ significantly (p=0.904). Thirteen PCa recurrences occurred (54.2%). Out-of-lesion-PCa was found in 12/13 patients (92.3%), while 4/13 patients showed in-lesion-PCa recurrence simultaneously (30.8%). In one patient, there was an in-lesion-PCa recurrence only (7.7%). Six out of 24 patients (25.0%) received a secondary treatment. All patients were satisfied with the IRE procedure.
Conclusions:
Focal IRE underperforms regarding the overall oncological outcome and should not be offered as an equivalent therapy to established curative treatment strategies. Nevertheless, under a strict FU regimen, its lack of significant additional morbidity compared to an active surveillance strategy makes IRE a feasible alternative for low-risk PCa in highly selected patients as a personalised approach.
Insights
Focal irreversible electroporation (IRE) for prostate cancer shows poor oncological outcomes but is a feasible alternative to active surveillance for select patients due to low morbidity. Strict follow-up is essential.
Area of Science:
- Urology
- Oncology
- Minimally Invasive Therapies
Background:
- Active surveillance (AS) is a standard option for low-risk prostate cancer (PCa).
- Patients refusing AS or standard treatments require alternative focal therapies.
- Irreversible electroporation (IRE) is a focal therapy option for PCa.
Purpose of the Study:
- To evaluate the morbidity, functional, and oncological outcomes of focal IRE for PCa.
- To assess IRE in patients eligible for AS but refusing standard options.
Main Methods:
- Focal IRE performed under general anesthesia.
- Voiding parameters (IPSS, uroflowmetry, post-void residue) assessed pre- and post-intervention.
- Oncological outcome monitored via multi-parametric MRI, rebiopsy, PSA dynamics, and secondary treatment needs.
- Functional outcome assessed using IIEF and patient satisfaction.
Main Results:
- 54.2% of patients experienced PCa recurrence, mostly outside the treated lesion.
- Urinary voiding parameters (IPSS, Qmax) showed no significant post-IRE deterioration.
- 25% of patients required secondary treatment; all patients reported satisfaction with IRE.
Conclusions:
- Focal IRE demonstrates suboptimal oncological outcomes compared to established curative strategies.
- IRE presents a feasible, low-morbidity alternative to AS for highly selected low-risk PCa patients.
- A strict follow-up regimen is crucial for patients undergoing focal IRE.
