Irreversible electroporation for partial gland ablation: clinical application and outcomes

Prostate cancer (PCa) is the second most commonly diagnosed malignancy in men. Radical treatments such as radical prostatectomy and radiotherapy can be associated with morbidity that impact quality of life. Focal therapy has emerged as a promising alternative to radical whole-gland treatment, with irreversible electroporation (IRE) being a novel nonthermal ablation technique. IRE involves the application of high-voltage, short-duration electrical pulses to induce apoptosis while preserving critical structures such as nerves and blood vessels. This targeted approach aims to minimize adverse effects associated with radical treatments while maintaining oncological efficacy. Despite promising early outcomes, international guidelines have not yet fully endorsed IRE for PCa due to a lack of long-term randomized data. Current evidence suggests that IRE is most suitable for localized low- to intermediate-risk PCa, offering a middle ground between active surveillance and radical treatment. Additionally, salvage IRE has demonstrated potential in managing radio-recurrent PCa, with studies such as the Irreversible Electroporation (IRE) for Prostate Tumour Tissue in patients with Prostate Cancer (FIRE) and SAlvage Focal Irreversible Electroporation-For Recurrent Localized Prostate Cancer (SAFE) trials reporting favorable oncological and functional outcomes. Imaging plays a crucial role in patient selection and treatment planning, with multiparametric magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography being essential for disease localization. While prostate biopsy remains the gold standard for histological confirmation, the utility of tissue, urine, and serum biomarkers in focal therapy is still under investigation. Follow-up protocols for IRE are evolving, with consensus guidelines recommending prostate biopsy at one year, Prostate-specific antigen (PSA) monitoring, and serial multiparametric magnetic resonance imaging. Functional outcomes, including urinary and erectile function, require long-term assessment. While current studies suggest that IRE achieves high rates of local cancer control, out-of-field recurrence remains a concern. Further prospective trials are necessary to establish its role in the definitive management of PCa.