To evaluate longer-term oncological and functional outcomes of focal irreversible electroporation (IRE) as primary treatment for localised clinically significant prostate cancer (csPCa) at a median follow-up of 7 years (up to 12 years).

All patients that underwent focal IRE as primary treatment for localised PCa between February 2013 and February 2024 with a minimum 12 months of follow-up were analysed. Follow-up included 6-month magnetic resonance imaging (MRI) and standardised transperineal saturation template ± targeted biopsies at 12 months, and further biopsies in the case of clinical suspicion on serial imaging and/or prostate-specific antigen (PSA) levels. Failure-free survival (FFS) was defined as no progression to radical treatment or nodal/distant disease. Local recurrence was defined as any International Society of Urological Pathology Grade of ≥2 on biopsy.

A total of 376 patients were analysed with a median (interquartile range [IQR]) follow-up of 60 (40-80) months. The median (IQR) age was 67 (62-73) years, the median (IQR) PSA level was 5.8 (4.1-7.9) ng/mL. The clinically significant prostate cancer recurrent rate was 23.1% (87/376) overall. Of those patients, 0.3% (1/376) had active surveillance, and 9.6% (36/376) had a redo- IRE. In all, 63 patients progressed to radical treatment (16.8%) and overall failure free survival was 83.2%. PCa-specific survival was 100%. Continence and erectile function data is currently undergoing data analysis.

Focal therapy and IRE is becoming increasingly recognised as a valid treatment option for localised prostate cancer. Longer-term follow-up confirms our earlier findings that focal IRE provides acceptable local and distant oncological control in selected men. Ongoing external validation of these findings and randomised trials are required to establish this new treatment paradigm as the standard of care for localised prostate cancer