Irreversible electroporation for localized prostate cancer: risk-stratified oncologic outcomes and functional...

Prostate cancer (PCa) remains a leading cause of morbidity and mortality among men globally. Irreversible electroporation (IRE), a non-thermal ablation modality, selectively induces tumor cell apoptosis via high-voltage electrical pulses while sparing critical periprostatic structures. 10. (low-risk: 21, intermediate-risk: 21, and high-risk: 7). Serial assessments of PSA, MRI, urinary function (IPSS), and sexual outcomes (IIEF-5) were conducted at intervals of 3 to 6 months postoperatively. Median PSA nadir reached 1.69 ng/mL, with a cumulative clinically significant recurrence rate of 14.28% at a follow-up of up to months. PSA monitoring (>4 ng/ml) demonstrated a true positive rate of 57.1% (4/7 cases) for detecting clinically significant recurrence. Notably, sensitivity for PSA>10 ng/mL was limited to 28.6% (2/7 cases). Risk-stratified analysis revealed clinically significant recurrence rates of 4.8%, 19.0%, and 28.6% for low-risk, intermediate-risk, and high-risk cohorts, respectively. Postoperative complications included urinary incontinence (6.1%) and sexual dysfunction (4.1%), with no metastatic progression observed. These findings position IRE as a promising therapeutic strategy for localized PCa, offering favorable functional preservation and encouraging oncological control, particularly in low-to intermediate-risk patients. However, the elevated clinically significant recurrence rates observed in intermediate-high risk cohorts underscore two critical imperatives: first, the exploration of combined therapeutic regimens to mitigate recurrence risk, and second, establishing risk-stratified PSA thresholds and integrating advanced imaging biomarkers to enable dynamic postoperative surveillance.