We admit the patient for two to four days for treatment.
At the start of the treatment, we take ten to twelve tissue cores from various regions of the prostate (biopsies) and analyse them under the microscope. The procedure is controlled via trans-rectal ultrasound, an imaging method that uses ultrasonic waves (6).
If the investigated issue turns out to be cancerous, we then determine the stage of the disease. First we differentiate between local prostatic carcinomas (restricted to the prostate, without any metastases or lymph node involvement and without spread to the area around the prostate) and advanced prostatic carcinomas (with lymph node involvement or other distant metastases, spread to surrounding tissue or to neighbouring organs).
If the carcinoma is local, the laboratory results (prostate-specific antigen, PSA) and the tissue examinations (Gleason score) are then used to decide whether IRE would be appropriate.
IRE is carried out under general anaesthetic because the electric current applied can cause disruptive muscle twitching.
The electric fields are applied using thin needles which are introduced through the perineum into the tumour area (Figure 1). The needles are positioned under imaging guidance with constant visual monitoring. To ensure that we are able to proceed with complete precision, our facility uses image guidance involving the combination of MRI images obtained before the treatment with ultrasound images taken during the intervention (MRI-US fusion).
Once the needles have been inserted, treatment begins. The entire procedure takes around one hour.
The remainder of the dead tumour cells are then consumed (phagocyted) by the body’s own immune cells (macrophages) and disposed of.
Figure 1: Image-guided introduction of the IRE electrode through the perineum with the aid of a special template (grid). The entire procedure is carried out under constant image surveillance.
After the treatment, patients can go about their normal everyday lives without any restrictions.
After six to eight weeks and then every six months, we recommend an MRI scan of the prostate to check the result of the treatment and to rule out any cell changes in the prostate (lesions).
If the MRI scan is carried out elsewhere, we would be grateful if the image data could be sent to us via CD-ROM for further assessment and quality control. In addition to the MRI scan of the prostate, the success of the ablation should also be checked with the prostate-specific antigen (PSA).