Irreversible electroporation for partial gland ablation: clinical application and outcomes

Prostate cancer (PCa) is the second most commonly diagnosed malignancy in men. Radical treatments such as radical prostatectomy and radiotherapy can be associated with morbidity that impact quality-of-life. Focal therapy has emerged as a promising alternative to radical whole-gland treatment, with irreversible electroporation (IRE) being a novel non-thermal ablation technique. IRE involves the application of high-voltage, short-duration electrical pulses to induce apoptosis while preserving critical structures such as nerves and blood vessels. This targeted approach aims to minimise adverse effects associated with radical treatments while maintaining oncological efficacy. Despite promising early outcomes, international guidelines have not yet fully endorsed IRE for PCa due to a lack of long-term randomised data. Current evidence suggests that IRE is most suitable for localised low- to intermediate-risk PCa, offering a middle ground between active surveillance and radical treatment. Additionally, salvage IRE has demonstrated potential in managing radio-recurrent PCa, with studies such as the FIRE and SAFE trials reporting favourable oncological and functional outcomes. Imaging plays a crucial role in patient selection and treatment planning, with multiparametric MRI and PSMA PET being essential for disease localisation. While prostate biopsy remains the gold standard for histological confirmation, the utility of tissue, urine, and serum biomarkers in focal therapy is still under investigation. Follow-up protocols for IRE are evolving, with consensus guidelines recommending prostate biopsy at one year, PSA monitoring, and serial multiparametric MRI. Functional outcomes, including urinary and erectile function, require long-term assessment. While current studies suggest that IRE achieves high rates of local cancer control, out-of-field recurrence remains a concern. Further prospective trials are necessary to establish its role in the definitive management of PCa.