Irreversible electroporation for treating prostate cancer

Evidence-based recommendations on irreversible electroporation for treating prostate cancer. This involves using electrical pulses to destroy the cancer cells.

# Recommendations
Irreversible electroporation for treating prostate cancer should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do irreversible electroporation for treating prostate cancer should:
Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
Further research should ideally be randomised controlled trials with an appropriate comparator. Further research could also include analysis of registry data or research databases. It should include details of patient selection, details of the procedure (including imaging) and short- and long-term outcomes.
Why the committee made these recommendations
There is enough evidence to suggest that the procedure works and does not raise any major safety concerns in the short- and medium term. The procedure can have complications and it is uncertain how well it works in the long term. It is also uncertain who would benefit most from the procedure and at what stage of their prostate cancer treatment it would be most effective. So, it can be used with special arrangements, and further data collection is needed.# The condition, current treatments and procedure

# The condition
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.

# Current treatments
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.

# The procedure
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.
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.