Irreversible Electroporation (IRE) for Prostate Cancer
A focal therapy option for selected localised prostate cancer
Irreversible electroporation uses non-thermal electrical pulses to treat a defined area of prostate cancer while aiming to preserve surrounding tissue where appropriate.
Overview
Irreversible electroporation, or IRE, is a form of focal therapy used in selected men with localised prostate cancer. It is sometimes known by the device name NanoKnife.
Unlike surgery or radiotherapy, IRE does not treat the whole prostate. Instead, it aims to treat a defined area of cancer while preserving as much surrounding prostate tissue as possible.
IRE is not suitable for every man with prostate cancer. Careful assessment with PSA, MRI, prostate biopsy results, cancer grade, tumour location, prostate size, and overall health is needed before deciding whether focal treatment is appropriate.
At a Glance
| Key Point | What It Means |
|---|---|
| Treatment type | Focal therapy for selected localised prostate cancer |
| Energy used | Short electrical pulses |
| Main aim | To treat a defined cancer area while preserving surrounding prostate tissue where appropriate |
| Usually considered for | Carefully selected men with visible, localised prostate cancer |
| Follow-up | PSA monitoring, MRI, and clinical review |
| Important consideration | Suitability depends on MRI, biopsy findings, tumour location, and overall health |
What Is Irreversible Electroporation?
Irreversible electroporation uses short, high-voltage electrical pulses delivered through fine needles placed into the prostate.
These electrical pulses affect the membranes of targeted cells, leading to cell death in the treated area. Because IRE is not primarily heat-based, it may reduce thermal injury to nearby structures such as nerves, blood vessels, the urinary sphincter, and the urethra.
This non-thermal mechanism is one reason IRE may be considered for selected prostate cancers located close to important surrounding structures.
How IRE Is Different from Surgery or Radiotherapy
Radical prostatectomy removes the whole prostate. Radiotherapy treats the prostate using radiation, often involving the whole gland or a wider treatment field.
IRE is different because it aims to treat only the cancer-containing area of the prostate, rather than the entire gland.
This approach may be considered when the cancer is clearly visible, localised, and suitable for focal treatment. However, because untreated prostate tissue remains, ongoing surveillance is essential.
Who May Be Suitable for IRE?
IRE may be considered in selected men with localised prostate cancer where:
- The cancer is visible and well-defined on MRI
- The cancer is confined to the prostate
- The tumour location is suitable for focal treatment
- Biopsy results confirm the area and grade of cancer
- There is no evidence of more widespread or aggressive disease
- The patient understands the need for long-term follow-up
Suitability is highly individual. Some men are better treated with active surveillance, surgery, radiotherapy, or other treatment options.
Who May Not Be Suitable?
- The cancer is high-risk or more widespread within the prostate
- There are multiple significant cancer areas
- The cancer is not clearly visible or targetable
- There is evidence of spread outside the prostate
- The prostate anatomy makes treatment unsafe or unreliable
- The patient is unable to undergo anaesthesia or the required follow-up
A detailed discussion with a urologist is important before deciding whether IRE is suitable.
What Happens During IRE Treatment?
IRE is usually performed under general anaesthesia.
Using imaging guidance, fine needles are placed through the perineum — the skin between the scrotum and anus — into the planned treatment area of the prostate. Electrical pulses are then delivered between the needles to ablate the targeted tissue.
A urinary catheter may be placed temporarily after the procedure. The length of hospital stay varies depending on the centre, patient factors, and recovery.
Possible Benefits of IRE
For carefully selected patients, potential benefits may include:
- Treatment focused on the known cancer area
- Preservation of more normal prostate tissue
- No radiation exposure
- Non-thermal tissue ablation
- Potentially lower impact on urinary control and sexual function compared with whole-gland treatment
- Shorter recovery in some patients compared with major surgery
These benefits are not guaranteed. Outcomes depend on cancer characteristics, treatment planning, operator experience, and patient factors.
Possible Risks and Limitations
As with any prostate cancer treatment, IRE has potential risks and limitations. These should be discussed carefully before treatment so that expectations are clear.
Possible side effects may include:
- Blood in the urine or semen
- Urinary discomfort or increased frequency
- Temporary difficulty passing urine
- Urinary infection
- Perineal bruising or discomfort
- Changes in erectile function
- Urinary leakage, although this may be less common than with whole-gland treatment
Because IRE is a focal treatment, follow-up remains an important part of care. PSA monitoring, MRI, and clinical review help assess the treatment response and guide any further decisions if needed.
This approach allows treatment to be focused on the known cancer area while keeping future management options open.
Follow-Up After IRE
Follow-up is an important part of focal therapy.
After IRE, patients usually require:
- Regular PSA monitoring
- Follow-up MRI
- Clinical review
- Repeat biopsy in selected cases or according to protocol
- Ongoing monitoring to assess longer-term cancer control
A fall in PSA may occur after treatment, but PSA does not usually become undetectable because the prostate remains in place.
IRE Compared with Other Focal Therapies
IRE is one of several focal therapy options for selected men with localised prostate cancer. Other approaches may include HIFU, cryotherapy, focal brachytherapy, and other ablative techniques.
Each treatment works differently. IRE uses non-thermal electrical pulses, while HIFU uses focused ultrasound energy and cryotherapy uses freezing to treat targeted tissue.
The most suitable option depends on several factors, including tumour location, prostate anatomy, MRI and biopsy findings, available expertise, and the patient’s priorities.
Rather than choosing one focal therapy based on the technology alone, the decision should be based on whether the treatment is appropriate for the individual cancer pattern.
Important Considerations Before Choosing IRE
Before considering IRE, it is important to understand whether the cancer pattern is suitable for focal treatment.
IRE may be considered when the cancer is localised, clearly seen on MRI, and confirmed by biopsy. Careful assessment helps identify whether the treatment area can be planned accurately while preserving surrounding prostate tissue where appropriate.
Patients should understand that:
- IRE is intended for selected localised prostate cancers, not all prostate cancers
- MRI and biopsy findings are important for accurate treatment planning
- PSA monitoring and follow-up imaging help assess treatment response over time
- Further treatment options remain available if future assessment shows a need
- IRE should be discussed alongside other suitable options, including active surveillance, surgery, and radiotherapy
The aim is to choose a treatment that matches the cancer characteristics, prostate anatomy, and the patient’s priorities — not simply the least invasive option.
Considering Focal Therapy for Prostate Cancer?
Irreversible electroporation may be an option for selected men with localised prostate cancer, particularly when focal therapy is being considered.
A consultation allows the PSA trend, prostate MRI, biopsy results, cancer grade, tumour location, prostate anatomy, and overall health to be reviewed together before deciding whether IRE, HIFU, active surveillance, surgery, radiotherapy, or another approach is most appropriate.
Appointments with Dr Roger Anthony Idi are arranged through Prince Court Medical Centre.
Summary
Irreversible electroporation is a focal therapy option for selected men with localised prostate cancer. It uses short electrical pulses to destroy targeted prostate tissue without relying on heat or radiation.
Its main potential advantage is the ability to treat the known cancer area while preserving surrounding structures important for urinary and sexual function. However, IRE is not suitable for every patient, and long-term follow-up remains essential.
Treatment decisions should be based on careful assessment of the cancer, the patient’s health, and a balanced discussion of all suitable options.