Identifying the ideal candidate for irreversible electroporation in localized prostate cancer: a comprehensive narrative review from the EAU Section of Endourology.

Authors

Raffaele La Mura, Giuseppe Maiolino, Julien Anract, Massimo Valerio, Clement Orczyk, Ben Vanneste, Federico Zorzi, João Paulo Barbosa de Oliveira, Juan Ignacio Martínez-Salamanca, Eric Barret

Published in

BJU international. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

Irreversible electroporation (IRE) is an emerging non-thermal focal therapy for localized prostate cancer (PCa), offering tissue-selective ablation with functional preservation. This review aimed to delineate the 'ideal' candidate for primary IRE and provide practical guidance.
A narrative review (2014-2025) of primary IRE for localized PCa was conducted, including prospective series, multicentre registries, comparative studies, and systematic reviews. We synthesized baseline characteristics, lesion features, ablation strategy, oncologic/functional outcomes, and complications, focusing on cancer control and safety.
The best outcomes were reported in men with magnetic resonance imaging-visible, organ-confined intermediate-risk (International Society for Urological Pathology [ISUP] 2-3) PCa, typically presenting a single dominant unilateral index lesion characterized by multiparametric MRI and biopsy. Contemporary series show in-field ablation of clinically significant cancer in ~80-90% with high functional preservation. The main limitation is out-of-field recurrence (~15-25% of failures), reflecting PCa multifocality. In-field persistence at 12 months was ~16% in the PRESERVE trial. Lesion size is a key practical constraint; current evidence and electrode geometry favour targets generally ≤20 mm. Limited comparative evidence, largely from a single study, suggests better oncologic control with hemi-gland IRE (clinically significant PCa persistence 8.6%) versus focal ablation (25%), whereas focal IRE better preserves erectile function.
Primary IRE appears safe and effective in selected localized PCa. The ideal candidate has unilateral MRI-visible, organ-confined ISUP 2-3 disease, prostate-specific antigen density <0.15-0.20 ng/mL/cm³, and a lesion small enough for reliable electrode coverage. Hemi-gland templates may improve oncologic reliability, whereas focal ablation maximizes functional outcomes.
IRE is a focal, non-thermal treatment for localized PCa that can control the treated lesion while usually preserving urinary continence and often erectile function. Cancer can still occur elsewhere in the prostate after treatment, so follow-up is essential.

PMID:
42643154
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

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