Gielchinsky Ilan, Lev-Cohain Naama
Research Branch, Meuhedet Health Services, Tel-Aviv, Israel.
Department of Urology, Assaf Harofeh Medical Center, Tzrifin, Israel.
Res Rep Urol. 2023 Jan 22;15:27-35. doi: 10.2147/RRU.S393243. eCollection 2023.
Irreversible electroporation (IRE) technology for prostate cancer (PC) generates consecutive electrical pulses between pairs of electrodes which move through tumorous cells, irreversibly perforate their membranes and eventually lead to cell death, while avoiding tissue thermal effect. The technique is used for primary focal lesions as well as for focal salvage cases. This series reports short term oncological control, quality of life and safety results.
Retrospective data were collected from 45 consecutive cases of primary (N=38) and salvage (N=7) PC patients treated with IRE. All patients had transperineal MRI/US fusion biopsy and PET-PSMA scan prior to treatment, to verify single lesion. Transperineal Nano-Knife IRE system was used in day-care theatre. Patients had 6 months mpMRI, blood PSA and 1 year confirmatory biopsy following procedure. Quality of life was recorded during the first year.
Median primary subgroup analysis (N=38): age 69 years, initial PSA 5.6 ng/dL, lesion size 0.8 mL and ISUP Group 2 (1-3). Median salvage subgroup analysis (N=7): age 76 years, initial PSA 11.9 ng/dL, lesion size 2.0 mL and ISUP Group 4 (1-5). Median catheter time 5 (3-7) days. No Clavien-Dindo>1 complications were reported nor re-admissions, incontinence, strictures or fistulas. 5% of patients were given PDE-5i drugs. Primary group PSA dropped by 39%, mpMRI clearance in 84%, out-field new lesion in 12%, in-field lesion in 4%. Biopsy at 1 year: 4 patients had out-field clinically significant PC, thus 3 had re-IRE and 1 had radiation therapy. Salvage subgroup MRI clearance was 60%, and 52% remained on active surveillance by 1 year.
IRE treatment for focal PC is safe for primary and salvage cases, if done by a meticulously skilled and trained team, and under strict protocols. The short term oncological results are promising especially for primary lesions. Long term oncological results will be published over time.
用于前列腺癌（PC）的不可逆电穿孔（IRE）技术在成对电极之间产生连续电脉冲，这些电脉冲穿过肿瘤细胞，不可逆地穿透其细胞膜并最终导致细胞死亡，同时避免组织热效应。该技术用于原发性局灶性病变以及局灶性挽救性病例。本系列报告了短期肿瘤学控制、生活质量和安全性结果。
收集了45例连续接受IRE治疗的原发性（N = 38）和挽救性（N = 7）PC患者的回顾性数据。所有患者在治疗前均进行了经会阴MRI/超声融合活检和PET-PSMA扫描，以确认单一病变。在日间手术室使用经会阴纳米刀IRE系统。术后患者进行了6个月的mpMRI、血液PSA检查以及1年的确诊活检。在第一年记录生活质量。
原发性亚组分析中位数（N = 38）：年龄69岁，初始PSA为5.6 ng/dL，病变大小0.8 mL，ISUP分级为2级（1 - 3）。挽救性亚组分析中位数（N = 7）：年龄76岁，初始PSA为11.9 ng/dL，病变大小2.0 mL，ISUP分级为4级（1 - 5）。中位导尿管留置时间为5（3 - 7）天。未报告Clavien-Dindo>1级并发症，也无再次入院、尿失禁、尿道狭窄或瘘管情况。5%的患者使用了PDE-5i药物。原发性组PSA下降了39%，mpMRI显示清除率为84%，野外新病变率为12%，野外病变率为4%。1年时活检：4例患者有野外临床显著前列腺癌，因此3例接受了再次IRE治疗，1例接受了放射治疗。挽救性亚组MRI清除率为60%，到1年时52%的患者仍在进行积极监测。
如果由技术精湛且训练有素且严格遵循方案的团队进行，IRE治疗局灶性PC对原发性和挽救性病例都是安全的。短期肿瘤学结果很有前景，尤其是对于原发性病变。长期肿瘤学结果将随时间公布。
