Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer

Matthijs J Scheltema; Bart Geboers; Alexandar Blazevski; Paul Doan; Athos Katelaris; Shikha Agrawal; Daniela Barreto; Ron Shnier; Warick Delprado; James E Thompson; Phillip D Stricker

doi:10.1111/bju.15946

Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer

BJU Int. 2023 Jun:131 Suppl 4:6-13. doi: 10.1111/bju.15946. Epub 2022 Dec 28.

Authors

Matthijs J Scheltema^{1

2}, Bart Geboers^{1

2}, Alexandar Blazevski^{1

2

3}, Paul Doan^{1

2

3}, Athos Katelaris^{1

2}, Shikha Agrawal^{1

2}, Daniela Barreto^{1

2}, Ron Shnier⁴, Warick Delprado⁵, James E Thompson^{1

2

3}, Phillip D Stricker^{1

2

3}

Affiliations

¹ Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.
² Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia.
³ St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁴ I-MED Radiology, Sydney, NSW, Australia.
⁵ Douglass Hanly Moir Pathology, Sydney, NSW, Australia.

PMID: 36495481
DOI: 10.1111/bju.15946

Abstract

Objectives: To evaluate longer-term oncological and functional outcomes of focal irreversible electroporation (IRE) as primary treatment for localised clinically significant prostate cancer (csPCa) at a median follow-up of 5 years (up to 10 years).

Patients and methods: All patients that underwent focal IRE as primary treatment for localised PCa between February 2013 and August 2021 with a minimum 12 months of follow-up were analysed. Follow-up included 6-month magnetic resonance imaging (MRI) and standardised transperineal saturation template ± targeted biopsies at 12 months, and further biopsies in the case of clinical suspicion on serial imaging and/or prostate-specific antigen (PSA) levels. Failure-free survival (FFS) was defined as no progression to radical treatment or nodal/distant disease. Local recurrence was defined as any International Society of Urological Pathology Grade of ≥2 on biopsy.

Results: A total of 229 patients were analysed with a median (interquartile range [IQR]) follow-up of 60 (40-80) months. The median (IQR) age was 68 (64-74) years, the median (IQR) PSA level was 5.9 (4.1-8.2) ng/mL, and 86% harboured intermediate-risk disease and 7% high-risk disease. In all, 38 patients progressed to radical treatment (17%), at a median (IQR) of 35 (17-53) months after IRE. Kaplan-Meier FFS rates were 91% at 3 years, 84% at 5 years and 69% at 8 years. Metastasis-free survival was 99.6% (228/229), PCa-specific and overall survival were 100% (229/229). Residual csPCa was found in 24% (45/190) during follow-up biopsy and MRI showed a complete ablation in 82% (186/226). Short-term urinary continence was preserved (98%, three of 144 at baseline, 99%, one of 131 at 12 months) and erections sufficient for intercourse decreased by 13% compared to baseline (71% to 58%).

Conclusion: Longer-term follow-up confirms our earlier findings that focal IRE provides acceptable local and distant oncological control in selected men with less urinary and sexual toxicity than radical treatment. Long-term follow-up and external validation of these findings, is required to establish this new treatment paradigm as a valid treatment option.

Keywords: #PCSM; #Prostate Cancer; #uroonc; ablation; focal therapy; irreversible electroporation; localised prostate cancer; primary treatment.

MeSH terms

Aged
Electroporation / methods
Humans
Male
Prostate / diagnostic imaging
Prostate / pathology
Prostate-Specific Antigen*
Prostatic Neoplasms* / pathology
Treatment Outcome

Substances

Prostate-Specific Antigen

Abstract

MeSH terms

Substances

Grants and funding