Salvage irreversible electroporation for locally recurrent prostate cancer after definitive radiotherapy: a systematic review

To systematically evaluate the available evidence regarding the effect of salvage irreversible electroporation (IRE) in patients with local recurrent prostate cancer (PCa) after definitive radiotherapy (RT).

A systematic search was conducted in the electronic databases PubMed-MEDLINE and the Web of Science. The following search terms were used: “irreversible electroporation AND recurrent prostate cancer”, ‘’salvage irreversible electroporation AND prostate cancer AND radiation”, “nanoknife AND recurrent prostate cancer”, and ‘’salvage irreversible electroporation AND prostate cancer” by combining PICO (population, intervention, comparison, and outcome) terms.

We identified 5 eligible studies. Following IRE, local oncological control was ranging from 67 to 78%. In-field and out-field lesion recurrences after IRE were ranging from 3 to 10% and from 8 to 14%, respectively. Only one study reported an overall metastasis-free survival rate of 91% and a 5-year progression-free survival rate of 60%. The post-IRE continence status ranged 73–100%. Two studies reported a decline in the proportion of patients maintaining erections sufficient for sexual intercourse and two studies reported 50% preservation of erection. The majority of complications were of a low-to-mild nature, classified as Clavien–Dindo grade I-II, with the exception of the development of a rectal fistula in a single case.

IRE represents an alternative salvage treatment option for patients with localised recurrent PCa following RT. The procedure offers a favourable safety profile and effective preservation of urinary function. The oncological results are promising, but further investigation is required.