TY - JOUR
T1 - Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer
AU - Scheltema, Matthijs J.
AU - Geboers, Bart
AU - Blazevski, Alexandar
AU - Doan, Paul
AU - Katelaris, Athos
AU - Agrawal, Shikha
AU - Barreto, Daniela
AU - Shnier, Ron
AU - Delprado, Warick
AU - Thompson, James E.
AU - Stricker, Phillip D.
N1 - Funding Information: Phillip Stricker is a paid consultant with AngioDynamics. Matthijs Scheltema received an educational grant from AngioDynamics. Bart Geboers received research funding from AngioDynamics. All other authors have no interests to declare. Funding Information: The authors acknowledge Cancer Institute New South Wales (NSW) Grant, Ramsay Foundation, St Vincent's Prostate Cancer Centre for funding support, Shikha Agrawal‐Clinical Research Coordinator, IT Applications Group and CANSTO Database at Garvan Institute. Publisher Copyright: © 2022 BJU International.
PY - 2022
Y1 - 2022
N2 - Objectives: To evaluate longer-term oncological and functional outcomes of focal irreversible electroporation (IRE) as primary treatment for localised clinically significant prostate cancer (csPCa) at a median follow-up of 5 years (up to 10 years). Patients and Methods: All patients that underwent focal IRE as primary treatment for localised PCa between February 2013 and August 2021 with a minimum 12 months of follow-up were analysed. Follow-up included 6-month magnetic resonance imaging (MRI) and standardised transperineal saturation template ± targeted biopsies at 12 months, and further biopsies in the case of clinical suspicion on serial imaging and/or prostate-specific antigen (PSA) levels. Failure-free survival (FFS) was defined as no progression to radical treatment or nodal/distant disease. Local recurrence was defined as any International Society of Urological Pathology Grade of ≥2 on biopsy. Results: A total of 229 patients were analysed with a median (interquartile range [IQR]) follow-up of 60 (40–80) months. The median (IQR) age was 68 (64–74) years, the median (IQR) PSA level was 5.9 (4.1–8.2) ng/mL, and 86% harboured intermediate-risk disease and 7% high-risk disease. In all, 38 patients progressed to radical treatment (17%), at a median (IQR) of 35 (17–53) months after IRE. Kaplan–Meier FFS rates were 91% at 3 years, 84% at 5 years and 69% at 8 years. Metastasis-free survival was 99.6% (228/229), PCa-specific and overall survival were 100% (229/229). Residual csPCa was found in 24% (45/190) during follow-up biopsy and MRI showed a complete ablation in 82% (186/226). Short-term urinary continence was preserved (98%, three of 144 at baseline, 99%, one of 131 at 12 months) and erections sufficient for intercourse decreased by 13% compared to baseline (71% to 58%). Conclusion: Longer-term follow-up confirms our earlier findings that focal IRE provides acceptable local and distant oncological control in selected men with less urinary and sexual toxicity than radical treatment. Long-term follow-up and external validation of these findings, is required to establish this new treatment paradigm as a valid treatment option.
AB - Objectives: To evaluate longer-term oncological and functional outcomes of focal irreversible electroporation (IRE) as primary treatment for localised clinically significant prostate cancer (csPCa) at a median follow-up of 5 years (up to 10 years). Patients and Methods: All patients that underwent focal IRE as primary treatment for localised PCa between February 2013 and August 2021 with a minimum 12 months of follow-up were analysed. Follow-up included 6-month magnetic resonance imaging (MRI) and standardised transperineal saturation template ± targeted biopsies at 12 months, and further biopsies in the case of clinical suspicion on serial imaging and/or prostate-specific antigen (PSA) levels. Failure-free survival (FFS) was defined as no progression to radical treatment or nodal/distant disease. Local recurrence was defined as any International Society of Urological Pathology Grade of ≥2 on biopsy. Results: A total of 229 patients were analysed with a median (interquartile range [IQR]) follow-up of 60 (40–80) months. The median (IQR) age was 68 (64–74) years, the median (IQR) PSA level was 5.9 (4.1–8.2) ng/mL, and 86% harboured intermediate-risk disease and 7% high-risk disease. In all, 38 patients progressed to radical treatment (17%), at a median (IQR) of 35 (17–53) months after IRE. Kaplan–Meier FFS rates were 91% at 3 years, 84% at 5 years and 69% at 8 years. Metastasis-free survival was 99.6% (228/229), PCa-specific and overall survival were 100% (229/229). Residual csPCa was found in 24% (45/190) during follow-up biopsy and MRI showed a complete ablation in 82% (186/226). Short-term urinary continence was preserved (98%, three of 144 at baseline, 99%, one of 131 at 12 months) and erections sufficient for intercourse decreased by 13% compared to baseline (71% to 58%). Conclusion: Longer-term follow-up confirms our earlier findings that focal IRE provides acceptable local and distant oncological control in selected men with less urinary and sexual toxicity than radical treatment. Long-term follow-up and external validation of these findings, is required to establish this new treatment paradigm as a valid treatment option.
KW - #PCSM
KW - #Prostate Cancer
KW - #uroonc
KW - ablation
KW - focal therapy
KW - irreversible electroporation
KW - localised prostate cancer
KW - primary treatment
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85145276227&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36495481
UR - http://www.scopus.com/inward/record.url?scp=85145276227&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bju.15946
DO - https://doi.org/10.1111/bju.15946
M3 - Article
C2 - 36495481
SN - 1464-4096
JO - BJU international
JF - BJU international
ER -