Irreversible Electroporation of Carcinoma of the Prostate Gland with a Focus on Localized Carcinoma of the Prostate Gland: A Review and Update

Abstract

Even though adenocarcinoma of the prostate gland could be lethal in its advanced stage, adenocarcinoma of the prostate gland can be effectively treated when the carcinoma is localized to the prostate gland and when the localized adenocarcinoma is a low-risk or intermediate-risk localized adenocarcinoma of the prostate gland. it is localized. Traditionally, radical prostatectomy (RP) or radical radiotherapy (RT) in the form of either external beam radiotherapy or brachytherapy were utilized to treat all men who have localized adenocarcinoma of the prostate gland as treatment of curative intent. Nevertheless, Radical prostatectomy and radical radiotherapy do tend to be associated with significant risks of post-treatment side effects. Some patients who have localized prostate cancer may not be medically fit as a result of their comorbidities to undergo radical prostatectomy or radical radiotherapy to their prostate cancers. Over recent years a number of less-invasive treatment options are being utilized for the treatment of some localized adenocarcinomas of the prostate gland and some of the treatment options include: Cryotherapy of prostate Cancer; Radiofrequency ablation of prostate cancer, High Intensity Focused Ultrasound Treatment of Prostate Cancer and Irreversible Electroporation of prostate cancer as focal ablation or whole gland ablation. Focal therapy has emerged as a potential form of treatment that can achieve similar oncological outcomes to radical treatment while preserving functional outcomes and decreasing rates of adverse effects. Irreversible electroporation (IRE) is one such form of focal therapy which utilizes pulsatile electrical currents to ablate tissue. This modality of treatment is still in an early research phase, with studies showing that IRE is a safe procedure that can offer good short-term oncological outcomes whilst carrying a lower risk of poor functional outcomes. Irreversible Electroporation (IRE) is a new radiology image-guided tissue ablation which does induce cell death through very short but strong electric fields. IRE had been demonstrated to have preserving properties towards vessels, nerves, as well as the extra-cellular matrix. For this reason, IRE could represent an ideal treatment option for adenocarcinoma where other treatment options including radical prostatectomy and radical radiotherapy tend to unselectively destroy that encompass the prostate cancer and inducing side effects including urinary incontinence as well as sexual dysfunction / impotence. Some results of studies in which IRE had been utilized for the treatment of curative intent of localized low-risk and intermediate-risk adenocarcinomas of the prostate gland had indicated complete efficacy of IRE to the standard of radical prostatectomy and standard radical radiotherapy with regard to the 5-year tumour recurrence rate as well as better preservation of genitourinary function which did prove the safety as well as suitability of IRE for the treatment of localized low-risk and intermediate risk adenocarcinoma of the prostate gland. Some data pertaining to IRE besides focal treatment of early adenocarcinoma of the prostate gland had shown that IRE besides focal treatment of early prostate cancer could also be utilized for whole prostate gland ablations in patients who develop recurrent prostate cancer as well as a problem-solving treatment for the control of local tumour within the prostate gland that are not amenable to surgery or radiotherapy anymore. Some studies had demonstrated comparable short-term and medium-term functional outcomes functional outcomes with radical prostatectomy and radical radiotherapy but following longer surveillance assessments those underwent IRE were found tom have superior genitourinary function in that a number of the sexual dysfunction and urinary incontinence had resolved but with regard to the oncology outcome repeat follow-up biopsy of the prostate had demonstrated a higher positive tumour biopsy upon pathology examination for which either further IRE, or radical radiotherapy, or radical prostatectomy was required as subsequent treatment of curative intent in that radical prostatectomy of curative intent had superior medium-term to long-term outcome in comparison with IRE. IRE can also be utilized to treat locally recurrent prostate cancer following: (a) radical radiotherapy and (b) following the finding of persistent or locally recurrent adenocarcinoma of the prostate gland pursuant the undertaking of IRE as treatment of curative intent of localized adenocarcinoma of the prostate gland. Following failure of IRE treatment for localized adenocarcinoma of the prostate, the persistent carcinoma of the prostate gland could also be treated by means of radical prostatectomy, or radical radiotherapy or any other minimally invasive treatment of curative intent including cryotherapy, radiofrequency ablation of the prostate and high intensity focused ultrasound treatment. Considering that IRE tends to be associated with good short-term and medium-term outcome which also tends to be generally superior to the outcome following radiotherapy as well as radical prostatectomy, and the fact that the medium-term to long-term oncology outcome tends to be good but the oncology outcome following radical prostatectomy as well as radiotherapy would tend to be a bit superior to IRE, it could be suggested that patients who have low-risk and intermediate-risk localized adenocarcinoma who prefer to maintain their genitourinary function could be offered IRE as first line treatment of curative intent which should be followed up with regular frequent assessments which would enable early identification of treatment failures at an early stage. The individuals who are found to have IRE failure could then be offered radical prostatectomy or radical radiotherapy as second line treatment of curative intent. Finally, there is need for a global multi-centre trial of IRE in the treatment of curative intent of localized low-risk, intermediate-risk, as well as high risk groups and those who have high risk group localized prostate cancer could be offered adjuvant therapy and all these treatments should be compared with radical radiotherapy and radical prostatectomy with a long period of follow-up to enable a consensus opinion to be established as well as guidelines to be formulated.