Focal Therapy of Prostate Cancer

Nicolai Hübner; Shahrokh F. Shariat; Mesut Remzi

Disclosures

Curr Opin Urol. 2018;28(6):550-554. 

In This Article

Electroporation

Irreversible electroporation (IRE) uses electrical pulses between electrodes to create pores in the cell membrane, which leads to apoptosis. It is one of the newer methods described for focal therapy of the prostate and, like cryotherapy, requires a transperineal approach for the placement of the electrodes.

IRE has been proven to completely ablate tissue in the chosen field without affecting surround tissue.[21] This is a theoretical advantage, as with thermal ablation techniques, surround tissue gets affected by dispersing heat, thus making complete spearing of neurovascular structures almost impossible.

A recent study by van den Bos et al.[22] shows promising QoL outcomes, as well as oncological outcomes, comparable to other focal therapy modalities. Overall, 63 patients with clinically significant PCa (high volume Gleason 6, or any Gleason sum 7) who were treated with IRE were analysed. There were no perioperative high-grade adverse events. Also, there was no significant difference in physical, mental, bowel or urinary QoL domains. Sexual QoL did decrease at the 6-month follow-up. Positive rebiopsy rate was 84 and 76% for in-field and whole-gland recurrence, respectively.[22]

Another study by Scheltema et al.[23] compared IRE with robot-assisted radical prostatectomy (RARP). In this matched-pair analysis, 50 IRE patients were matched to 50 RARP patients by propensity score. Patients with high volume Gleason 6 (ISUP 1) or any Gleason sum of 7 (ISUP 2 and 3) were included. There were no significant differences in the matched groups. IRE was superior to RARP in preserving pad-free continence (P = 0.01) as well as erectile function (P = 0.05) within the first 12 months. However, analysis of EPIC questionnaires showed no significant difference. Early oncological outcomes show 70.5% of men without significant cancer, although none of the patients in the RARP group experienced biochemical failure within the first 12 months.[23] This is one of few comparative studies between focal therapy and standard treatments. And, it is the opinion of the authors that with the long follow-up needed for PCa, and the constantly evolving therapies, matched-pair analysis might be the best possible data for newer treatments, especially as these treatments only work for selected patients, who often have specific wishes when considering treatment, and are unwilling to be randomized.

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