Oncological and Functional Outcomes of Hemi-Ablation Versus Focal Ablation for Localized Prostate Cancer Using Irreversible Electroporation

<b>Background</b>: Irreversible electroporation (IRE) is a novel ablative treatment modality for localized prostate cancer and aims at achieving oncological control while minimizing the related side effects. We present the functional and oncological outcomes of focal IRE ablation versus hemi-ablation from a single-center patient series. <b>Methods</b>: Men with histologically confirmed low-intermediate risk prostate cancer received focal IRE ablation or hemi-ablation. All the patients were recommended an MRI-targeted fusion biopsy plus systematic biopsy at 1 year post-IRE ablation. The functional outcomes were measured by the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) questionnaires. <b>Results</b>: In total, 106 patients were recruited in this study. The median follow-up time was 24 months (IQR 15-36). Overall, 94 patients underwent repeat prostate biopsy at 12 months after IRE. Persistent tumor was detected in 72.2% in the focal ablation group and in 31% in the hemi-ablation group (<i>p</i> < 0.001). Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 25% in the focal ablation group and in 8.6% in the hemi-ablation group (<i>p</i> = 0.003). There was no significant difference between the two groups in terms of IPSS and IIEF at each follow-up time point. <b>Conclusion</b>: For men with localized low-intermediate risk prostate cancer, hemi-IRE ablation treatment displayed better oncological control than focal ablation without compromising on functional or sexual outcomes.