Irreversible electroporation for treating prostate cancer

2.1 Prostate cancer is the most common cancer in men in the UK. Most prostate cancers are either localised or locally advanced at diagnosis. Localised prostate cancer does not usually cause any symptoms, but some people might have urinary problems or erectile dysfunction. Some people may not identify as men but may have a prostate.

2.2 Current treatments for localised prostate cancer include active surveillance, radical prostatectomy, external beam radiotherapy, brachytherapy, and ablation of the whole gland using cryotherapy or high-intensity focused ultrasound (as recommended in NICE's guideline on prostate cancer: diagnosis and management). Hormone therapy (androgen deprivation or anti-androgens) is usually the primary treatment for metastatic prostate cancer, but is increasingly being used for locally advanced, non-metastatic disease.

2.3 The aim of irreversible electroporation is to destroy cancerous cells by subjecting them to a series of short electrical pulses using high-voltage direct current. This creates multiple holes in the cell membrane, irreversibly damaging the cell's homeostatic mechanisms and leading to cell death.

2.4 The procedure is done with the person under general anaesthesia. A neuromuscular blocking agent is essential to prevent uncontrolled severe muscle contractions caused by the electric current. Several electrode needles (typically 3 to 5) are introduced transperineally and inserted into, and adjacent to, the tumour in the prostate using image guidance. A series of short electrical pulses is delivered over several minutes to ablate the tumour. The electrodes may then be repositioned to extend the zone of electroporation until the entire tumour and an appropriate margin have been ablated.