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584 Early clinical experience of focal therapy for localised prostate cancer using irreversible electroporation
584
Early clinical experience of focal therapy for localised prostate cancer using irreversible electroporation Eur Urol Suppl 2013;12;e584
Dickinson C.L.1, Valerio M.1, Ahmed H.U.1, Freeman A.2, Allen C.3, Emberton M.1 1
University College London Hospitals NHS Foundation Trust, Dept. of Urology, London, United Kingdom, 2University
College London Hospitals NHS Foundation Trust, Dept. of Histopathology, London, United Kingdom, 3University College London Hospitals NHS Foundation Trust, Dept. of Radiology, London, United Kingdom INTRODUCTION & OBJECTIVES: Early clinical studies of focal therapy for localised prostate cancer have demonstrated favourable genito-urinary outcomes but variable levels of significant toxicity and early histological outcomes. This may be due, in part, to the type of ablative energy. Irreversible Electroporation (IRE) is a novel therapy, which is in the early phase of evaluation in treating solid organ tumours. We report on our early clinical experience using IRE for prostate cancer. MATERIAL & METHODS: Retrospective clinical data review from men treated with focal IRE by a single clinician. Disease burden and localisation was assessed on multi-parametric (mp)MRI and transperineal prostate biopsy. PSA nadir levels were assessed in those men with at least 3 months’ post-operative results. Continence and erectile function status was assessed from clinical notes and patient self-reporting. Adverse events were graded according to NIH Common Terminology Criteria (CTCAE). RESULTS: Fifteen consecutive men received focal IRE treatment (08/2011-09/2012) for low, intermediate and highrisk disease (D’Amico classification) in 7%, 80% and 13%, respectively. IRE was received as primary treatment in 9 men, and salvage in 6 (following HIFU in 4/6, and EBRT in 2/6). Mean age at treatment was 65 years (range 48 – 73 years) and PSA 5.9ng/ml (range 1.2 – 12.2). Mean tumour volume was 0.84cc, with an average ablative volume of 10cc (range 1.4-17.5), on mpMRI. Procedure time took under 40 minutes in all cases, with no intra-operative complications. Intra-operative catheterisation (suprapubic or urethral) was performed with successful removal a mean 4 days post-operatively (range 2-9). 27% (4/15) of men had grade 1 and 20% (3/15) grade 2 post-operative adverse events. There were no severe adverse events. Mean PSA nadir was 3.3 (from 9/15 patients). In those with available data, continence and erectile function were preserved in 100% (6/6), with new PDE5-I use in 17% (1/6). CONCLUSIONS: Early clinical experience demonstrates encouraging toxicity in this small cohort. Oncological outcomes are awaited. Further prospective trial evaluation of this technology for focal treatment of localised prostate cancer is now required.
Early clinical experience of focal therapy for localised prostate cancer using irreversible electroporation Eur Urol Suppl 2013;12;e584
Dickinson C.L.1, Valerio M.1, Ahmed H.U.1, Freeman A.2, Allen C.3, Emberton M.1 1
University College London Hospitals NHS Foundation Trust, Dept. of Urology, London, United Kingdom, 2University
College London Hospitals NHS Foundation Trust, Dept. of Histopathology, London, United Kingdom, 3University College London Hospitals NHS Foundation Trust, Dept. of Radiology, London, United Kingdom INTRODUCTION & OBJECTIVES: Early clinical studies of focal therapy for localised prostate cancer have demonstrated favourable genito-urinary outcomes but variable levels of significant toxicity and early histological outcomes. This may be due, in part, to the type of ablative energy. Irreversible Electroporation (IRE) is a novel therapy, which is in the early phase of evaluation in treating solid organ tumours. We report on our early clinical experience using IRE for prostate cancer. MATERIAL & METHODS: Retrospective clinical data review from men treated with focal IRE by a single clinician. Disease burden and localisation was assessed on multi-parametric (mp)MRI and transperineal prostate biopsy. PSA nadir levels were assessed in those men with at least 3 months’ post-operative results. Continence and erectile function status was assessed from clinical notes and patient self-reporting. Adverse events were graded according to NIH Common Terminology Criteria (CTCAE). RESULTS: Fifteen consecutive men received focal IRE treatment (08/2011-09/2012) for low, intermediate and highrisk disease (D’Amico classification) in 7%, 80% and 13%, respectively. IRE was received as primary treatment in 9 men, and salvage in 6 (following HIFU in 4/6, and EBRT in 2/6). Mean age at treatment was 65 years (range 48 – 73 years) and PSA 5.9ng/ml (range 1.2 – 12.2). Mean tumour volume was 0.84cc, with an average ablative volume of 10cc (range 1.4-17.5), on mpMRI. Procedure time took under 40 minutes in all cases, with no intra-operative complications. Intra-operative catheterisation (suprapubic or urethral) was performed with successful removal a mean 4 days post-operatively (range 2-9). 27% (4/15) of men had grade 1 and 20% (3/15) grade 2 post-operative adverse events. There were no severe adverse events. Mean PSA nadir was 3.3 (from 9/15 patients). In those with available data, continence and erectile function were preserved in 100% (6/6), with new PDE5-I use in 17% (1/6). CONCLUSIONS: Early clinical experience demonstrates encouraging toxicity in this small cohort. Oncological outcomes are awaited. Further prospective trial evaluation of this technology for focal treatment of localised prostate cancer is now required.