The IRE is performed as a short inpatient procedure. Discharge is on the first day after treatment. A bladder catheter is inserted under anaesthesia before the start of treatment to protect the urethra and prevent urinary retention after surgery. The bladder catheter is usually removed only a few days after the procedure.
The treatment must be performed under general anaesthesia. The strong electric shocks would otherwise cause massive muscle contractions. During the procedure, the electrodes are placed over the perineum. A template (like for "sinking ships") is helpful here. The template contains a coordinate system and holes that allow the surgeon to place the electrodes precisely.
The coordinate system of the template is compared with the coordinates of the mpMRI of the prostate and the ultrasound, so that the electrodes can be placed in the correct position. Depending on the size of the tumour, two to six electrodes are necessary for the treatment. The electrodes are placed at a distance of 1.5 to 2 centimetres and inserted evenly deep into the tissue.
Based on the data of the mpMRI as well as the mpMRI/TRUS-navigated fusion and template biopsy of the prostate, the IRE ablation field is planned individually
Needle-shaped electrodes are inserted via the perineum (transperineally) into the tumour areas under ultrasound control.
Voltages of several thousand volts are applied between two electrodes in the form of ultra-short pulses (10-100 millionths of a second).
Strong electric fields cause an irreversible breakdown of the cell membranes in the target area. Nanopores are created which lead to the death of the tumour cells.
The body's own defence cells eliminate the destroyed tumour cells.
Tumour cells are destroyed and degraded in the treatment field, the extracellular matrix remains intact. Anatomical structures (vessels, nerves and hollow organs) are spared.
"I define the chances of success with IRE or with a focal therapy for prostate cancer in general as follows: In the best case, we achieve complete and permanent tumour freedom. In the second best case, we buy ourselves time. Time to be able to lead a life that is as unrestricted as possible by the side effects of a radical treatment concept".
Prof. Dr. med. Gernot Bonkat
alta uro AG, Basel
As with all tumour treatments, the healing success after IRE must be carefully monitored. In this way, any complications or recurrence of tumours can be detected early. A first imaging check (mpMRI of the prostate) takes place after 6-12 months, depending on the tumour. In addition, regular PSA value checks and control biopsies of the prostate are carried out as part of the follow-up care.
The IRE (NanoKnife®) for the treatment of prostate carcinoma is offered throughout Switzerland only by alta uro in Basel.
