Irreversible electroporation for partial gland ablation: Clinical application and outcomes Book Section
| Authors: | Fainberg, J.; Coleman, J.; Marra, G.; Stricker, P.; Lawrentschuk, N. |
| Editors: | Polascik, T. J.; de la Rosette, J.; Sanchez-Salas, R. |
| Article/Chapter Title: | Irreversible electroporation for partial gland ablation: Clinical application and outcomes |
| Abstract: | When performing focal therapy for the treatment of primary localized prostate cancer, a surgeon may have access to many tools in their arsenal, and the selection of the appropriate energy modality is crucial to a successful outcome. From afar, these energies may be divided into two categories: thermal versus athermal. Thermal energies such as cryoablation, lasers, and high-intensity-focused ultrasound (HIFU) use temperature to kill prostate cells, whereas athermal energies such as electroporation and photodynamic therapy use alternate means to destroy tissue and offer other potential advantages due to the athermal nature of the cellular destruction. Irreversible electroporation (IRE) uses electrical pulses between electrodes to create pores in the cell membrane, leading to apoptosis and cell death. In the treatment of prostate cancer, the electrodes are placed transperineally to surround the targeted tumor lesion with a safety margin, and high-voltage electrical pulses are delivered to induce cell wall permeability. High voltage electrical pulses (HVEPs) have been applied in several soft tissue tumors as these HVEPs cause cell death by inducing membrane disruption, transiently increasing cell membrane permeability. During an IRE procedure to treat prostate cancer, the patient is typically placed in the high lithotomy position after induction of general anesthesia with complete paralysis. A transrectal ultrasound probe is placed to visualize the prostate, and the tumor location, size, and margin needed are mapped out. Electrodes are placed via the perineum, and these electrodes are meant to be placed in parallel orientation to one another to ensure an even flow of electricity between probes. Additionally, the length of each electrode is controlled by the surgeon and ranges in length. A minimum of two electrodes are needed to induce a sufficient electric field, but practically, when treating a prostate tumor, however focal, a minimum of three electrodes are utilized. Short-and medium-term outcomes prove IRE is safe and effective for the ablation of prostate cancer. The largest IRE multicenter trial (PRESERVE) has completed enrollment in the United States, and finalized results are awaited. This will include functional, biochemical, and MRI data in addition to the primary endpoint of posttreatment biopsy outcomes in all patients and 5-year follow-up. These trial results may boost IRE as it seeks to be a routinely used means of focal and partial gland treatment of prostate cancer, much like other energy sources such as HIFU and Cryoablation. In the United Kingdom, the cancer guidelines (NICE) have recently accepted IRE along with HIFU and Cryotherapy as an ablation modality. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024. |
| Book Title: | Imaging and Focal Therapy of Early Prostate Cancer. 3rd ed |
| ISBN: | 978-3-031-66753-4 |
| Publisher: | Springer Nature |
| Publication Place: | Cham, Switzerland |
| Date Published: | 2024-01-01 |
| Start Page: | 345 |
| End Page: | 351 |
| Language: | English |
| DOI: | 10.1007/978-3-031-66754-1_29 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Book Chapter: 29, located in 'Part VII: Transperineal Technologies for Focal Therapy' -- Source: Scopus |
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