Percutaneous prostate cryo-ablation has become an accepted treatment for primary prostate cancer. Thermal tissue ablation based on cold, however, does have some distinct limitations. These include, variable damage at the cryo lesions margin, injury to adjacent structures such as rectum, urethra and NVB (neurovascular bundle), and long procedure time due to the need for multiple freeze thaw cycles, that have limited the acceptance of this modality. Irreversible electroporation IRE, is a new non-thermal ablation modality that uses short pulses of DC electric current to create irreversible pore in the cell membrane, thus, causing cell death. This method theoretically should have significant advantages in ablating prostate tissue. Six males dogs had their prostates treated using IRE. Pulses were applied using a DC generator that delivered pulses in the microsecond range of duration, with a variable pulse interval and voltage range. IRE probes were placed percutaneously or trans-rectally using trans-rectal ultrasound guidance. In one of the dogs, the lesions were made purposely to include the rectum, urethra, and neurovascular bundle (NVB). Subjects were followed for 1 to 14 days before sacrifice. IRE lesions in the prostate had unique characteristics compared to thermal lesions. The margins of the IRE lesions was very distinct with a narrow zone of transition from normal to complete necrosis, there was complete destruction within the IRE lesion, and rapid resolution of the lesions with marked shrinkage within two weeks. Structures such as urethra, vessels, nerves, and rectum were unaffected by the IRE application. IRE lesions have characteristics that are distinctly different than thermal lesions. The differences could be very advantageous in a clinical setting, improving the results and acceptance of prostate ablation.
[1]
L. Mir,et al.
[Electrochemotherapy, a new antitumor treatment: first clinical trial].
,
1991,
Comptes rendus de l'Academie des sciences. Serie III, Sciences de la vie.
[2]
B. Rubinsky,et al.
Tissue Ablation with Irreversible Electroporation
,
2005,
Annals of Biomedical Engineering.
[3]
Boris Rubinsky,et al.
Cancer Cells Ablation with Irreversible Electroporation
,
2005,
Technology in cancer research & treatment.
[4]
E. Neumann,et al.
Gene transfer into mouse lyoma cells by electroporation in high electric fields.
,
1982,
The EMBO journal.
[5]
Anil Kumar,et al.
Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer.
,
2002,
Urology.
[6]
S. Tanaka.
Immunological aspects of cryosurgery in general surgery.
,
1982,
Progress in clinical and biological research.
[7]
Boris Rubinsky,et al.
Irreversible Electroporation: A New Ablation Modality — Clinical Implications
,
2007,
Technology in cancer research & treatment.