Image-guided Irreversible Electroporation of Localized Prostate Cancer: Functional and Oncologic Outcomes
Federico Collettini , Judith Enders, Carsten Stephan, Thomas Fischer, Alexander D.J. Baur, Tobias Penzkofer, Jonas Busch, Bernd Hamm, Bernhard Gebauer
Author Affiliations
From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.).
Address correspondence to F.C. (e-mail: federico.collettini@charite.de).
Published Online:Jun 4 2019https://doi.org/10.1148/radiol.2019181987
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Abstract
MRI–transrectal US fusion–guided irreversible electroporation is a safe and effective procedure for patients with localized low- to intermediate-risk prostate cancer with promising midterm results, both in terms of urogenital toxicity and oncologic control.

Background
Irreversible electroporation (IRE) is a nonthermal ablative method based on the formation of nanoscale defects in cell membranes leading to cell death. Clinical experience with the technique for treatment of prostate cancer remains limited.

Purpose
To evaluate urogenital toxicity and oncologic outcome of MRI–transrectal US fusion–guided IRE of localized prostate cancer.

Materials and Methods
In this prospective study, men with biopsy-proven, treatment-naive, low- to intermediate-risk prostate cancer (prostate-specific antigen [PSA], ≤15 ng/mL; Gleason score, ≤3 + 4; clinical stage, ≤T2c; lesion size at multiparametric MRI, ≤20 mm) underwent focal MRI/transrectal US fusion–guided IRE between July 2014 and July 2017. Primary end point was the urogenital toxicity profile of focal IRE by using participant-reported questionnaires. Secondary end points were biochemical, histologic, and imaging measures of oncologic control. Analyses were performed by using nonparametric and χ2 test statistics.

Results
Thirty men were included (median age, 65.5 years); mean PSA level was 8.65 ng/mL and mean tumor size was 13.5 mm. One grade III adverse event (urethral stricture) was recorded. The proportion of men with erection sufficient for penetration was 83.3% (25 of 30) at baseline and 79.3% (23 of 29; P > .99) at 12 months. Leak-free and pad-free continence rate was 90% (27 of 30) at baseline and 86.2% (25 of 29; P > .99) at 12 months. Urogenital function remained stable at 12 months according to changes in the modified International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms, or ICIQ-MLUTS, and the International Index of Erectile Function, or IIEF-5, questionnaires (P = .58 and P = .07, respectively). PSA level decreased from a baseline median value of 8.65 ng/mL (interquartile range, 5–11.4 ng/mL) to 2.35 ng/mL (interquartile range, 1–3.4 ng/mL) at 12 months (P < .001). At 6 months, 28 of 30 participants underwent posttreatment biopsy. The rate of in-field treatment failure was 17.9% (five of 28) as determined with multiparametric prostate MRI and targeted biopsies at 6 months.

Conclusion
After a median follow-up of 20 months, focal irreversible electroporation of localized prostate cancer was associated with low urogenital toxicity and promising oncologic outcomes.

© RSNA, 2019