In a study reported in JAMA Surgery, Zhang et al found that focal and extended irreversible electroporation (IRE) produced similar results in the ablation of low- or intermediate-risk prostate cancer.
Study Details
In the study, 106 patients from five European centers were randomly assigned between July 2015 and February 2020 to receive focal IRE (n = 51) or extended IRE (n = 55). The primary efficacy measure was presence of clinically significant prostate cancer (International Society of Urological Pathology [ISUP] grade ≥ 2) on transperineal template-mapping prostate biopsy at 6 months after IRE.
Key Findings
On biopsy 6 months after IRE, clinically significant prostate cancer was detected in 9 patients (18.8%) in the focal IRE group vs 7 patients (13.2%) in the extended IRE group (P = .29). In the focal IRE group, positive cores were found outside the treated area in 17 patients (35.4%), in the treated area in 3 (6.3%), and both in and outside the treated area in 5 (10.4%). In the extended IRE group, positive cores were found outside the treated area in 10 patients (18.9%), in the treated area in 9 (17.0%), and both in and outside the treated area in 2 (3.8%).
Clinically significant cancer was found in the treated area in 5 (10.4%) of 48 patients in the focal IRE group vs 5 (9.4%) of 53 in the extended IRE group (P = .64). Protocol-defined treatment failure (persistent cancer of similar or different grade in the treated area or high volume [≥ 3 mm] ISUP grade 1 tumor foci or ISUP grade 2 tumor foci in the untreated area) was reported for 12 (25.0%) of 48 patients in the focal IRE group vs 12 (22.6%) of 53 in the extended IRE group (P = .82).
The investigators concluded, “This study found that focal and extended IRE ablation achieved similar oncological outcomes in [patients] with localized low- or intermediate-risk prostate cancer. Because some patients with intermediate-risk prostate cancer are still candidates for active surveillance, focal therapy may be a promising option for those patients with a high risk of cancer progression.”
Jean de la Rosette, PhD, MD, of the Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was funded by AngioDynamics. For full disclosures of the study authors, visit jamanetwork.com.
