Objectives: To determine the safety, quality of life and short-term oncological outcomes of IRE for primary and salvage treatment of prostate cancer (PCa). To identify potential risk factors for oncological failure.
Materials and methods: Patients that met both the consensus guidelines on patient criteria and selection methods for primary and salvage focal therapy were analysed. 91 men with organ-confined clinically significant PCa (i.e. high-volume Gleason sum score 6 or Gleason 7 for primary, any Gleason for salvage) were treated with focal IRE. Oncologic, adverse event and quality of life outcome data were analysed. Wilcoxon’s Signed Rank Test and Wilcoxon’s Rank Sum Test were used to assess statistically significant differences in paired continuous variables and unpaired continuous variables respectively. All analyses were performed for primary IRE and salvage IRE separately.
Results: A total of 91 patients were included, 63 patients underwent primary IRE treatment, 28 patients as salvage treatment. No high-grade adverse events occurred. Quality of life analysis demonstrated no significant change in overall, physical, mental, bowel and urinary QoL; there was a mild decrease in sexual Qol scores in both the primary IRE cohort (median EPIC score 66 at baseline vs 48 at 12 months) and in the salvage cohort who predictably had lower baseline sexual QoL (median EPIC score 36 at baseline vs 24 at 12 months). Compared to baseline PSA a decline of 70% (1.8, IQR 0.96-4.8) and 83% (0.65, IQR 0.21-3.5) was seen between 6-12 months for primary and salvage patients respectively. In-field and whole-gland oncological control on follow up biopsies was 84% (38/45) and 76% (34/45) for primary and 83% (10/12) and 75% (9/12) for salvage, this increased to 97% (38/39) and 87% (34/39) for primary and 100% (10/10) and 90% (9/10) for salvage when patient were excluded treated with a narrow safety margin and/or system errors.
Conclusions: Our data supports the safety and feasibility of IRE in both the primary and salvage setting as a potentially effective treatment of localized primary and recurrent PCa in carefully selected men.
Conflict of interest: The authors have nothing to disclose.
