Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Jun:131 Suppl 4:23-31.
doi: 10.1111/bju.15947. Epub 2023 Jan 9.

Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial

Alexandar Blazevski  1   2   3 , Bart Geboers  1   2 , Matthijs J Scheltema  1   2 , William Gondoputro  1   2 , Paul Doan  1   2   3 , Athos Katelaris  1   2 , Shikha Agrawal  1   2 , Daniela Baretto  1   2 , Jayne Matthews  1   2 , Anne-Maree Haynes  1   2 , Warick Delprado  4 , Ron Shnier  5 , Willemien van den Bos  6 , James E Thompson  1   2   3 , Nathan Lawrentschuk  7   8 , Phillip D Stricker  1   2   3
Affiliations
Multicenter Study

Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial

Alexandar Blazevski et al. BJU Int. 2023 Jun.

Abstract

Objectives: To prospectively assess the safety, functional- and oncological-outcomes of irreversible electroporation (IRE) as salvage therapy for radio-recurrent focal prostate cancer in a multicenter setting.

Patients and methods: Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co-registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien-Dindo classification. Validated questionnaires were used for patient-reported functional outcomes. Follow-up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6-month mpMRI and standardised transperineal template mapping biopsies at 12-months. Thereafter follow-up was guided by MRI and/or PSMA-PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies.

Results: 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22-43) months. Median age was 71 (53-83), median PSA was 3.5 ng/mL (2.7-6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self-limiting urgency, frequency, or hematuria (grade 1-2). Seven patients (19%) developed a grade 3 AE; urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months.

Conclusion: The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.

Keywords: Irreversible electroporation; Localised prostate cancer; ablation; focal therapy; radiation failure; salvage treatment.

PubMed Disclaimer

Comment in

References

    1. Ma TM, Chu FI, Sandler H et al. Local failure events in prostate cancer treated with radiotherapy: A pooled analysis of 18 randomised trials from the meta-analysis of randomised trials in cancer of the prostate consortium (LEVIATHAN). Eur Urol 2022; 82: 487-98
    1. Van den Broeck T, van den Bergh RCN, Briers E et al. Biochemical recurrence in prostate cancer: The European Association of Urology prostate cancer guidelines panel recommendations. Eur Urol Focus 2020; 6: 231-4
    1. Coen JJ, Zietman AL, Thakral H, Shipley WU. Radical radiation for localised prostate cancer: Local persistence of disease results in late wave of metastasis. J Clin Oncol 2002; 20: 3190-205
    1. Krishan AU, Chu FI, King CR et al. Local failure and survival after definitive radiotherapy for aggressive prostate cancer: An individual patient-level meta-analysis of six randomized trials. Eur Urol 2020; 77: 201-8
    1. Pfister D, Kokx R, Hartmann F, Heidenreich A. Salvage radical prostatectomy after local radiotherapy in prostate cancer. Curr Opin Urol 2021; 31: 194-8

Publication types

Substances