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Updated: May 5, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Perioperative Safety and Early Oncologic Outcomes of Salvage Irreversible Electroporation for Radiorecurrent Prostate
Jarrett Noakes1,2, Katherine Wainwright1,2, Elias Hyams1,2
1Department of Urology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Background:
Local recurrence after definitive radiotherapy for prostate cancer (PCa) remains a challenging clinical problem. Salvage irreversible electroporation (sIRE) is a non-thermal focal ablation approach with limited published evidence in the radiorecurrent setting. We report safety and early oncologic outcomes of sIRE for these patients.
Methods:
We performed a retrospective review of consecutive patients undergoing sIRE at a single institution (December 2023 to June 2025). Inclusion required biopsy-confirmed intraprostatic recurrence and PSMA PET demonstrating no metastatic disease. Outcomes included perioperative morbidity, early PSA response, and post-treatment prostate MRI findings.
Results:
Eighteen patients underwent sIRE. Mean age was 73.78 ± 7.0 years. Seventeen patients were discharged on the day of surgery. Postoperative urinary morbidity included urinary tract infection in 3 patients (16.7%), urinary retention requiring limited TURP in 2 (11.1%), and new bothersome storage lower urinary tract symptoms requiring treatment in 2 (11.1%). Mean PSA decreased from 5.37 ± 2.09 ng/mL pre-IRE to 1.61 ± 1.57 ng/mL at approximately 3 months, and 2.17 ± 1.92 ng/mL at approximately 6 months. Twelve patients underwent post-IRE prostate MRI; results included post-treatment change, or ablation defect, or susceptibility artifact in most patients. One patient underwent repeat PSMA PET for a rising PSA and was found to have a PSMA-avid lung lesion consistent with metastatic disease.
Conclusions:
Salvage IRE for radiorecurrent prostate cancer has generally manageable short-term urinary morbidity and encouraging early PSA responses, with limited utility of post-treatment MRI. A longer follow-up is needed to define durability and optimal selection.
