Salvage IRE for Radio-Recurrent Prostate Cancer: FIRE Trial

What is it about?

The FIRE trial was a prospective, multicenter clinical trial that investigated the safety, functional, and oncological outcomes of irreversible electroporation (IRE) ablation in men with radio-recurrent prostate cancer. The trial demonstrated that salvage IRE is well tolerated, safe, and has satisfactory functional outcomes with minimal toxicity. The study had a median follow-up of 29 months, and the local control was achieved in 78% of patients, with 73% clear of local and systemic disease. Adverse events were reported following the Clavien-Dindo classification, and cooling of electrodes is currently under investigation to reduce the risk of urethral sloughing in the future. The trial had a small sample size and short to median term oncological follow-up, and further studies are required to replicate these outcomes.

Featured Image

Why is it important?

This research is important because it provides valuable insights into the safety, functional, and oncological outcomes of irreversible electroporation (IRE) as a salvage therapy for radio-recurrent focal prostate cancer. It is the first prospective, multicenter clinical trial investigating the use of focal IRE ablation in men with radio-recurrent prostate cancer, and it demonstrates that salvage IRE is safe, well-tolerated, and offers promising outcomes with minimal toxicity. This study contributes to the understanding of the management of radio-recurrent prostate cancer, which is a challenging condition with limited treatment options. Key Takeaways: 1. Salvage IRE as a treatment for radio-recurrent prostate cancer is safe, well-tolerated, and shows promising functional and oncological outcomes. 2. The trial demonstrated that 29 out of 37 patients (78%) achieved local control, with 93% of patients remaining continent and 73% clear of local and systemic disease. 3. Although adverse events were reported, they were secondary to urethral sloughing and were successfully managed with transurethral resection. 4. The decline in urinary and sexual quality of life was minimal, considering this was a salvage procedure. 5. Focal IRE ablation offers an alternative to other salvage treatments, such as salvage high-intensity focused ultrasound (sHIFU) and salvage cryotherapy, with more favorable continence preservation rates. 6. Further studies are required to confirm the long-term outcomes and to investigate the potential benefits of cooling electrodes to reduce the risk of urethral sloughing.