[Image-Guided Irreversible Electroporation for the Treatment of Localized Prostate Cancer]

Focal treatment has emerged as a precision-oriented alternative to whole-gland treatment approaches for localized prostate cancer. It aims to selectively destroy clinically significant tumor foci while preserving surrounding structures that are essential for urinary continence and sexual function. Irreversible electroporation (IRE) is a relatively new and increasingly investigated focal treatment modality. By delivering short high-voltage pulses, IRE creates permanent nanopores in cell membranes and induces cell death predominantly through non-thermal mechanisms.This theoretical advantage - tissue ablation with relative preservation of the collagen-rich extracellular matrix - has heightened interest in IRE, particularly for tumors located near sensitive structures such as the neurovascular bundles, the urethral sphincter complex, and the rectal wall.In this review, we outline key procedural and technical aspects and summarize the clinical evidence for IRE in localized prostate cancer. Data from both prospective and retrospective case series demonstrate encouraging early and intermediate-term oncologic outcomes, although patterns of recurrence and the need for retreatment vary between cohorts and depend on the respective follow-up protocols. Functional outcomes are consistently excellent: continence is preserved in the vast majority of patients, and potency preservation is often high, typically ranging from approximately 75 to 95% among men who were potent prior to treatment.Despite these promising findings, widespread adoption in routine clinical practice is limited by the lack of robust long-term endpoints and the absence of randomized comparisons with established standards such as radical prostatectomy, radiotherapy, or risk-adapted active surveillance. While prospective comparative studies are highly challenging as they require large sample sizes, long follow-up periods, and careful endpoint definition, they are essential to clarify the role of irreversible electroporation within treatment algorithms, optimize patient selection, standardize follow-up and salvage strategies, and ultimately confirm durable tumor control with a sustained functional benefit.