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ECT – The alternative for large tumors and recurrences

The new alternative to radiotherapy for prostate cancer recurrence: electrochemotherapy (ECT).


Electrochemo-therapy (ECT)

The new alternative to radiotherapy for prostate cancer recurrence

Prostate cancer has high recurrence rates. Within 5 years after radical prostatectomy (RPE), carcinoma is expected to return in 10% to 25% of all cases (Gleason 7 and 8, PSA < 10), even if the carcinoma was confined to the prostate(Han Tables).

The return of the carcinoma is also called “biochemical recurrence” because it is detected by a renewed rise in the PSA level above zero.

Because it is unclear at this point exactly where the recurrence is located and reoperation is not possible, the entire “prostate bed,” the site where the prostate was removed and surrounding tissues, is irradiated in biochemical recurrences. This method is also used in so-called adjuvant radiotherapy, i.e. postoperative radiation as local tumor control.

However, radiation therapy causes irreversible damage to the irradiated tissues and organs. This leads to chronic irritation of the bladder and rectum with frequent urination and defecation, but also to incontinence or voiding disorders. In addition, radiation therapy triggers chronic inflammation and scarring, and genetic damage, which in turn can trigger cancer. Although radiotherapy does not guarantee a cure for prostate cancer and it may recur afterwards, it is not possible to receive radiation again because irreparable damage occurs when the maximum dose is exceeded.

So radiation therapy is a stopgap measure at best.

A much gentler alternative to radiation therapy is electrochemotherapy (ECT), a therapy related to Irreversible Electroporation (IRE – NanoKnife), which is based on electroporation. ECT, like radiotherapy, allows treatment of the entire prostate bed in cases of biochemical recurrence.

Instead of ionizing radiation, ECT uses pulsed electric fields that induce pores in cell membranes. The simultaneous, one-time administration of a cytotoxin that can enter the cells through the pores kills them. Since the cytotoxin can normally penetrate the cell membrane poorly, it selectively damages the “porated” cells in the ECT treatment field, where it develops a toxicity up to 1000 times higher than in the rest of the body.

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* Urinary incontinence, as it is called, is the lack or inability of the body to safely store and self-directly empty the contents of the bladder. This leads to involuntary loss of urine. While there are several possible definitions of incontinence, a long-term study of incontinence after prostatectomy** concludes that a reasonable definition of incontinence is when a patient requires 2 or more pads per day 12 months after prostate surgery.

** Sacco E, Prayer-Galetti T, Pinto F, et al. Urinary incontinence after radical prostatectomy: incidence by definition, risk factors, and temporal trend in a large series with a long-term follow-up. BJU Int. 2006;97:1234-41.

*** Syan, Raveen, and Victor W. Nitti. “Post-prostatectomy Incontinence Initial Evaluation.” Urinary Dysfunction in Prostate Cancer. Springer, Cham, 2016. 15-30.

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