As focal therapy becomes more common for localised prostate cancer, the question arises: how do we treat recurrences following focal therapy failure? One option is to deliver a second treatment if the recurrence is localised. This study aims to evaluate the success of a second irreversible electroporation treatment after failure of primary irreversible electroporation.

All patients that underwent redo IRE in the period 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.

A total of 36 patients were analysed. 44.4% (16/36) had a clinically significant recurrence (ISUP 2 or greater). Of those patients 8.3% (3/36) were suitable for active surveillance, 5.6% had a third IRE treatment (2/36), 16.7% (6/36) underwent salvage radical prostatectomy, and 13.9% (5/36) underwent salvage radiotherapy. Overall, 63.9% achieved good local control after 2 IRE treatments (defined as not needing salvage radical treatment or >2 IRE treatments). Data on functional outcomes including continence and erectile function are currently being analysed.

For patients who have prostate cancer recurrence after primary IRE treatment, a second IRE treatment achieve good control in the majority of cases and is safe. This is particularly significant for those patients who are not surgical candidates, who have had previous pelvic radiotherapy for other malignancies, or who are strongly focused on maintaining their erectile function and continence.