Department of Urology, QEII Jubilee Hospital, Brisbane, Australia.
The University of Queensland, School of Medicine, Brisbane, Australia.
Investig Clin Urol. 2022 May;63(3):285-293. doi: 10.4111/icu.20210472.
Focal irreversible electroporation (IRE) for prostate cancer aims to reduce quality of life complications, however outcomes data remains limited. We aimed to evaluate histological in-field clearance of prostate cancer at ≥12 months post-IRE.
Retrospective review of prospectively acquired data of consecutive patients treated between August 2018 and August 2021. Significant recurrence was defined as a ≥6 mm core Gleason 3+3, or ≥Gleason 3+4 with ≥4 mm tumour length. A second definition of any focus of International Society of Urological Pathology (ISUP) ≥2 was also analysed.
The median follow-up of the entire cohort is 23 months (range 3-39 mo). For 64 primary IRE procedures, surveillance biopsy was performed in 40/50 (80.0%) with ≥12 months follow-up. Significant in-field recurrence occurred in 3/40 (7.5%), or 4/40 (10.0%) with any focus of ISUP >2. Significant out-of-field recurrence occurred in 5/40 (12.5%). In salvage IRE, three patients (3/6, 50.0%) have undetectable prostate-specific antigen levels, two have no residual cancer on biopsy and one patient had out-of-field recurrence. For sexually active men, erectile function was maintained in 24/28 (85.7%) of primary IRE. No incontinence developed in primary IRE (0/64).
Focal primary IRE for prostate cancer is associated with 90% infield ablation of any ISUP grade >2 cancer with a low risk of urinary incontinence or impotence. Surveillance prostate biopsies are required to exclude progression despite a normal post-IRE multiparametric magnetic resonance imaging (mpMRI). Salvage IRE is a promising option for localised recurrence after prostate radiotherapy with low morbidity.
前列腺癌的局灶性不可逆电穿孔（IRE）旨在减少生活质量并发症，但结果数据仍然有限。我们旨在评估 IRE 后≥12 个月前列腺癌的组织学场内清除率。
回顾性分析 2018 年 8 月至 2021 年 8 月连续治疗的患者的前瞻性采集数据。显著复发定义为≥6 毫米核心 Gleason 3+3，或≥Gleason 3+4 且肿瘤长度≥4 毫米。还分析了国际泌尿病理学会（ISUP）≥2 的任何焦点的第二个定义。
整个队列的中位随访时间为 23 个月（范围 3-39 个月）。对于 64 例原发性 IRE 手术，40/50 例（80.0%）进行了≥12 个月的随访，进行了监测活检。40 例中有 3 例（7.5%）或 40 例中有 4 例（10.0%）出现明显场内复发，ISUP 任何焦点>2。发生场外复发 5 例（12.5%）。在挽救性 IRE 中，3 例（3/6，50.0%）患者的前列腺特异性抗原水平无法检测到，2 例患者活检未见残留癌症，1 例患者出现场外复发。对于有性生活的男性，28 例原发性 IRE 中有 24 例（85.7%）保持勃起功能。原发性 IRE 无尿失禁（0/64）。
前列腺癌的局灶性原发性 IRE 与任何 ISUP 分级>2 癌症的 90%场内消融相关，尿失禁或阳痿的风险较低。尽管 IRE 后多参数磁共振成像（mpMRI）正常，但需要进行前列腺活检以排除进展。对于前列腺放疗后的局部复发，挽救性 IRE 是一种有前途的选择，其发病率较低。
