St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia.
Garvan Institute of Medical Research, Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
BJU Int. 2020 Mar;125(3):369-378. doi: 10.1111/bju.14951. Epub 2019 Dec 5.
Whilst whole-gland radical treatment is highly effective for prostate cancer control, it has significant impact on quality of life and is unnecessary 'over-treatment' in many men with screening-detected prostate cancer. Improvements in prostate biopsy and imaging have led to increased interest in partial gland ablation to reduce treatment-related morbidity. Several energies for focal ablation have been trialled. Irreversible electroporation (IRE) is a novel technology that ablates tissue by delivering direct current between electrodes. This narrative review documents the history of electroporation including its scientific basis, early data from pre-clinical animal studies, and contemporary clinical outcomes from the use of IRE in prostate cancer.
A literature search using the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), PubMed and Google Scholar was undertaken to identify historical perspectives and current clinical data relating to IRE for prostate cancer.
The history of electroporation and its implementation as a prostate cancer treatment was following the basic scientific principles, in vitro data, then animal studies, and now short- to medium-term clinical cohorts in humans. The results of IRE on >283 patients have been published in several papers, with preserved rates of (pad-free) continence in 91-100% of men and preserved erectile function in 79-100% of men. In-field recurrence rates range from 0% to 33%. The current state of evidence for IRE for the treatment of primary and salvage prostate cancer is considered as Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) stage 2B.
IRE is a new focal ablative technology for the treatment of localised prostate cancer in carefully selected men. Published cohorts report encouraging short-term oncological and functional outcomes; however, longer-term data are needed to validate this treatment before it can be recommended for widespread clinical use.
虽然全腺体根治性治疗对前列腺癌的控制非常有效，但它对生活质量有重大影响，而且在许多筛查发现的前列腺癌患者中是不必要的“过度治疗”。前列腺活检和影像学的改进导致人们对减少治疗相关发病率的部分腺体消融术产生了更大的兴趣。已经尝试了几种用于局灶性消融的能量。不可逆电穿孔（IRE）是一种通过在电极之间施加直流电来消融组织的新技术。本叙述性综述记录了电穿孔的历史，包括其科学依据、来自临床前动物研究的早期数据以及在前列腺癌中使用 IRE 的当代临床结果。
使用医学文献分析和检索系统在线（MEDLINE）、Excerpta Medica 数据库（EMBASE）、PubMed 和 Google Scholar 进行文献检索，以确定与前列腺癌的 IRE 相关的历史观点和当前临床数据。
电穿孔的历史及其作为前列腺癌治疗方法的实施遵循基本的科学原理、体外数据、然后是动物研究，现在是人类的短期至中期临床队列。已有几篇论文发表了超过 283 名患者的 IRE 结果，91-100%的男性保留了（无尿垫）控尿功能，79-100%的男性保留了勃起功能。场内复发率为 0%至 33%。目前认为，IRE 治疗原发性和挽救性前列腺癌的证据处于 Idea、Development、Exploration、Assessment、Long-term follow-up（IDEAL）阶段 2B。
IRE 是一种治疗局限性前列腺癌的新型局灶性消融技术，适用于精心挑选的男性。已发表的队列报告了令人鼓舞的短期肿瘤学和功能结果；然而，需要更长时间的数据来验证这种治疗方法，然后才能推荐广泛的临床应用。
