title: Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control.
abstract: BACKGROUND
  Current data on the use of irreversible electroporation (IRE) in the treatment of prostate cancer (PCa) is limited. We aim to evaluate the safety, short-term functional and oncological outcomes of focal IRE in low-intermediate risk PCa.
  
  
  METHODS
  Between February 2013 and May 2014, 32 consecutive men underwent IRE at a single centre. Patients with low-intermediate risk PCa who had not received previous PCa treatment were included for analysis. The tumour was ablated using 3-6 electrodes, ensuring a minimum 5-mm safety margin around the visible magnetic resonance imaging (MRI) lesion. Follow-up included recording Clavien complications, Expanded Prostate Cancer Index Composite (EPIC) questionnaires (baseline, 1.5, 3, 6 months), 6-month multi-parametric MRI (mp-MRI) and 7-month biopsy. Findings on mp-MRI and biopsy were sub-divided into infield, adjacent or outfield of the treatment zone.
  
  
  RESULTS
  Twenty-five men were included for final analysis. Safety follow-up revealed one Clavien Grade 3 complication and five Grade 1 complications. Functional follow-up confirmed no significant change in American Urological Association urinary symptom score, sexual or bowel function. Infield, there were no suspicious findings on mp-MRI (n=24) or biopsy (n=21) in all patients. Adjacent to the treatment zone, five (21%) had suspicious findings on mp-MRI with four (19%) proving to be significant on biopsy. Outfield, there were two (8%) with suspicious findings on mp-MRI and one (5%) significant finding on biopsy. For the five patients with significant findings on follow-up biopsy, one is awaiting repeat IRE, one had radical prostatectomy and three remained on active surveillance.
  
  
  CONCLUSIONS
  In selected patients with low-intermediate risk PCa, focal IRE appears to be safe with minimal morbidity. There were no infield recurrences and 76% of patients were histologically free of significant cancer at 8 months. Almost all recurrences were adjacent to the treatment zone, and this was addressed by widening the treatment margins.
authors.affiliation: St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.|School of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-5805-9860
authors.initials: F
authors.lastname: Ting
authors.affiliation: St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.|School of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Tran
authors.affiliation: Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Böhm
authors.affiliation: St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.|School of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Siriwardana
authors.affiliation: St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Van Leeuwen
authors.affiliation: Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Haynes
authors.affiliation: Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Delprado
authors.affiliation: Southern Radiology, Randwick, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Shnier
authors.affiliation: St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.|Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.|School of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: P D
authors.initials: PD
authors.lastname: Stricker
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D053672:Electrochemotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011859:Radiography; D016896:Treatment Outcome