Prostate cancer treatment with electrochemotherapy (ECT): safety, efficacy and clinical experience in 144 patients

Prostate cancer (PCa) is a common cancer in men in developed countries. PCa treatment depends on the disease's stage; focal therapy provides an intermediate approach, with lower toxicity compared to radical prostatectomy, and better tumor control than active surveillance. We report the first retrospective analysis of prostate cancer patients treated with ECT at our institution.

A cohort of 144 men with prostate cancer who were ineligible for or refused standard therapies were included and treated with ECT. Routine follow-up included PSA tests and MRI scans, as well as toxicity and genitourinary function evaluation by means of standard questionnaires. Local response was evaluated with MRI at 3 months after treatment, following the RECIST criteria for solid tumors.

The procedure was technically successful in all patients and was well tolerated, with mild and temporary adverse events. Urinary and erectile functions were mostly preserved. A complete response was observed in 75% of evaluated patients, a partial response in 18%, stable disease in 5%, and disease progression in 2%. Short-term response was associated with TNM stage (p < 0.05), Gleason score (p = 0.0066), and pre-ECT PSA levels (p = 0.0070). During follow-up, 18 patients (13%) experienced disease progression; 1-year PFS was 88% (95% CI: 80%-97%) and was found to be significantly associated with tumor stage and pre-treatment PSA levels.

ECT is a feasible, safe, and effective treatment for prostate cancer, with extremely low toxicity and side effects. Preliminary results suggest that it offers promising outcomes in terms of local disease control in early-stage tumors, but also in locally advanced cases where other treatments may not be viable.