Total gland treatment with radical surgery or radiation is the standard of care to treat localized prostate cancer but they have major potential side effect mainly loss of ejaculation, erectile dysfunction and urinary incontinence. Focal Therapy in prostate cancer aims at treating the well defined cancer lesion sparing the rest of the gland thus preserving function and avoiding the side effects of total gland therapy. We report our experience, the first in the middle east, in treating patients with localized prostate cancer using Irreversible Electroporation.

Over the last two years and to date 31 selected patients with localized prostate cancer were treated. All patients had suspicious mp-MRI and underwent MR/US Fusion prostate biopsies both target and random. All patients had PSA<15ng/ml, had intermediate risk Gl 7; 3+4 or 4+3. Only one patient had Gl8(4+4). 29 patients had single positive lesion and two patients had bilateral lesions. All patients consented to the procedure knowing that the disease might recur and the need for salvage therapy. All patients were done as outpatient under general anesthesia with muscle relaxation using the NanoKnife from Angiodynamics providing Irreversible Electroporation (IRE) to destroy the tumor lesion with a good margin. Foley was kept for 24 hrs and all patients were discharged on alpha blockers and antibiotics. Follow up regimen included PSA and MRI at 6 months and one year along with a biopsy at one year.

All patients tolerated the procedure well. Two patients required re catheterization for retention and two had hematuria. There was no change in erectile function in all patients but three patients reported ejaculation changes. None of the patients complained of any urinary incontinence. PSA dropped in all patients at 6 months and the MRI showed impressive treatment effect. PSA rose in 5 patients between 6 months and one year. Four of 12 biopsies at one year showed recurrent cancer. One in-field and 3 out of field. Three had Robotic Assisted Radical Prostatectomy and one radiation therapy. All data will be presented in detail.

Focal therapy using IRE, in the properly selected patients, can provide good cancer control and save the patients the side effects of whole gland therapy that stays with the patient and affect QOL. Patients must understand that recurrence will happen and must accept the concept of salvage therapy