Prostate cancer is one of the most common cancers in men, and treatment options have expanded in recent years. While surgery and radiation therapy remain widely used, they can affect surrounding tissue and lead to side effects.
Because of this, there has been increasing interest in more targeted approaches. One of these is electroporation, a technique that uses short electrical pulses to affect cancer cells in a different way than heat- or cold-based treatments.
What is Electroporation?
Electroporation is a technique that uses short electrical pulses to affect the outer membrane of cells. These pulses create tiny openings, or pores, that allow substances to pass in and out of the cell.
At lower intensities, this effect is temporary and increases the permeability of the cell membrane. At higher intensities, the electrical pulses can permanently disrupt the membrane, which leads to cell death.
Unlike many other cancer treatments, electroporation does not rely on thermal energy to destroy tissue. Instead, it works directly at the cellular level, which is why it is often described as a non-thermal approach.
This method has been used in both research and clinical settings, including applications in cancer treatment where controlled cell disruption or targeted drug delivery is required.
Types of Electroporation Used in Prostate Cancer
Electroporation used in prostate cancer generally falls into two categories: irreversible electroporation (IRE) and reversible electroporation (RE), which is often combined with chemotherapy in a method known as electrochemotherapy (ECT).
Both approaches are used as part of focal treatment strategies, where the goal is to target specific areas of cancer within the prostate while limiting the impact on surrounding tissue.
Irreversible Electroporation (IRE)
Irreversible electroporation uses higher-intensity electrical pulses to permanently disrupt cancer cell membranes. This leads to targeted cell death without the use of thermal energy.
The procedure is typically performed using thin needle electrodes placed into the prostate under image guidance, allowing the treatment area to be matched to the shape and location of the tumour.
Clinical experience with irreversible electroporation in prostate cancer has been evaluated in several cohort studies. In one retrospective analysis, 471 treatments were performed in 429 patients, with follow-up of up to six years.¹
Reported outcomes showed preservation of urinary continence in evaluated patients and relatively low rates of long-term erectile dysfunction, with approximately 3% of patients reporting persistent dysfunction at 12 months.
Recurrence rates varied depending on tumour grade, with lower rates observed in lower-risk disease and higher rates in more advanced cases. Outcomes were reported as comparable to surgical cohorts in similar risk groups.
Reversible Electroporation and Electrochemotherapy (ECT)
Reversible electroporation involves lower-intensity electrical pulses that temporarily open the cell membrane. This allows chemotherapy drugs to enter cancer cells more effectively before the membrane closes again.
When combined with chemotherapy, this approach is known as electrochemotherapy and is used to improve local drug delivery within the targeted area.
Clinical data from a cohort of 144 prostate cancer patients treated between 2017 and 2024 provides insight into how this approach performs in practice, including in patients with high-risk and locally advanced disease.² This represents one of the most detailed clinical datasets currently available for electrochemotherapy in prostate cancer.
Reported outcomes from this group include a 75% complete response rate at three months and an 88% one-year progression-free survival rate. Overall disease progression was observed in a smaller proportion of patients during follow-up.
The procedure was also reported to have a favorable safety profile, with no severe complications and only minor localized side effects. Functional outcomes such as urinary continence were preserved in previously continent patients, and persistent severe erectile dysfunction was reported in less than 1% of cases.
How Electroporation Differs from Other Focal Therapies
Focal therapies use different methods to destroy cancer cells within the prostate. Electroporation differs from other approaches in several key ways:
- Non-thermal approach
Unlike treatments such as high-intensity focused ultrasound (HIFU) or cryotherapy, electroporation does not rely on heat or freezing to destroy tissue, reducing the risk of collateral damage from thermal spread. - Cell membrane mechanism
Electroporation works by affecting the cell membrane directly using electrical pulses, rather than damaging tissue through temperature changes. - Precision of treatment area
The treatment field is shaped by electrode placement, allowing it to be adjusted based on tumour size and location. - Reduced impact on surrounding structures
As a result, nearby nerves and blood vessels may be less affected. - Flexible clinical use
It can be used in localized, recurrent, and selected advanced prostate cancer cases. - Combination treatment potential
In some cases, different electroporation techniques may be combined to treat more complex tumours.
Evidence and Clinical Experience
Clinical evidence for electroporation-based therapies in prostate cancer is still evolving, with much of the available data derived from retrospective and single-center analyses.
Published cohorts evaluating both irreversible electroporation (IRE) and electrochemotherapy (ECT) provide insight into treatment feasibility, tumour response, and functional outcomes across a range of disease stages.¹²
Across these studies, reported findings include high technical success rates, measurable tumour response, and preservation of key functional outcomes such as urinary continence in many patients.
Longer-term clinical experience, including data collected from one of Europe’s longest running non-thermal prostate cancer programs, provides additional context on how these approaches are applied in practice and how outcomes evolve over time.
References
- Stevanovic M, Heringer M, Hjouj M, Zanasi A, Terlizzi F, Stehling MK. Prostate cancer treatment with electrochemotherapy (ECT): safety, efficacy and clinical experience in 144 patients. Radiol Oncol. 2025;59(4):597-606. Published 2025 Dec 16. doi:10.2478/raon-2025-0061
- Guenther E, Klein N, Zapf S, et al. Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments. PLoS One. 2019;14(4):e0215093. Published 2019 Apr 15. doi:10.1371/journal.pone.0215093