First Clinical Analysis of Electrochemotherapy in Prostate Cancer Reports 75% Complete Response in 144 Patients
A new clinical analysis from Vitus Privatklinik reports outcomes of electrochemotherapy (ECT) in prostate cancer, based on 144 patients treated between 2017 and 2024.
The study found a 75% complete response rate and 88% one-year progression-free survival, with most patients maintaining urinary continence and erectile function.
This is the largest clinical dataset to date evaluating electrochemotherapy in prostate cancer, where prior clinical evidence was limited to a single published case report.²
While standard treatments such as surgery and radiation can be effective, they are often associated with lasting side effects that significantly impact quality of life. These findings suggest electrochemotherapy may offer a different balance between tumour control and functional preservation.
The study was conducted by Vitus Privatklinik and led by Dr. Michael K. Stehling, who has more than 15 years of experience in electroporation-based cancer treatments. This summary is based on findings published in Radiology and Oncology.¹
Key Highlights
Study at a Glance
- 144 patients treated between 2017 and 2024
- Largest clinical dataset to date evaluating electrochemotherapy (ECT) in prostate cancer
- Retrospective clinical analysis conducted at a single specialized centre
- Includes a high proportion of advanced and previously treated patients
Key Findings
- 75% complete response rate at 3-month evaluation
- 88% one-year progression-free survival
- No severe treatment-related complications reported
- Urinary continence preserved in all previously continent patients
- Only one patient (0.7%) reported persistent severe erectile dysfunction beyond one year
- Strongest outcomes observed in patients with earlier-stage, lower-risk disease
What This Means
Provides early evidence to support further clinical investigation and potential broader adoption
Introduces one of the first clinical datasets evaluating electrochemotherapy in prostate cancer
Suggests a potential treatment pathway that may reduce the trade-off between tumour control and quality of life
Why This Study Matters for Prostate Cancer Treatment
Radical prostatectomy and radiation therapy remain the standard treatments for prostate cancer. While effective, they are frequently associated with long-term side effects, particularly urinary incontinence and erectile dysfunction.
As a result, there has been growing interest in focal therapies that aim to treat cancer more precisely while preserving surrounding structures.
These approaches differ in how they treat tissue, and in the trade-offs they present between effectiveness and side effects:
| Treatment Type | Mechanism | Key Consideration |
| Surgery / Radiation | Tissue removal or radiation damage | Effective but associated with urinary and sexual side effects |
| HIFU / Cryotherapy (focal thermal therapies) | Thermal (heat or freezing) ablation | Targeted, but thermal spread may affect surrounding tissue |
| Electrochemotherapy (ECT) (focal non-thermal therapy) | Non-thermal electroporation + chemotherapy | Localized drug delivery without heat or freezing |
Electrochemotherapy (ECT) represents a non-thermal approach within this group. It uses short electrical pulses to temporarily increase cell membrane permeability, allowing chemotherapy drugs such as bleomycin to enter tumour cells more effectively without the use of heat or freezing.
The technique is already used clinically for several cancers, including skin tumours, hepatocellular carcinoma, colorectal liver metastases, and bone metastases. However, its application in prostate cancer has remained largely unexplored, with prior clinical evidence limited to a single case report.
This study helps address that gap by providing one of the first and largest clinical datasets evaluating electrochemotherapy in prostate cancer, offering early insight into both tumour control and functional outcomes.
Study Design and Patient Population
Patient Cohort Summary
| Characteristic | Details |
| Total patients treated | 144 |
| Treatment period | 2017–2024 |
| ECT used as primary treatment | 66% |
| Previously treated patients | 34% |
| Previous treatments | IRE, systemic therapy, radiotherapy, surgery, focal ablation |
| High-risk disease | 86% |
| Locally advanced tumors (T3/T4) | 65% |
| Metastatic disease | 22% |
| Median PSA level | 15.1 ng/ml |
Between 2017 and 2024, 144 men with prostate cancer were treated with electrochemotherapy (ECT) at Vitus Privatklinik, representing the largest reported clinical cohort for this treatment approach.
The cohort included a substantial proportion of patients with advanced disease. Overall, 86% were classified as high-risk, 65% presented with locally advanced tumours (T3/T4), and 22% had metastatic disease.
Many patients had limited conventional treatment options. Some were not eligible for surgery or radiation, while others declined standard therapies due to concerns about side effects such as urinary incontinence or erectile dysfunction.
Electrochemotherapy was used as a primary treatment in most cases, while a smaller proportion of patients had received prior therapies, including IRE, systemic treatments, radiotherapy, surgery, or other focal ablation techniques.
| Variable | Mean | Median | Range |
| Age (years) | 68 | 67 | 50–83 |
| PSA level (ng/ml) | 24.9 | 15.1 | 1.8–177 |
| Prostate volume (ml) | 44 | 40 | 6–117 |
All patients underwent multiparametric MRI (mpMRI) prior to treatment to identify tumour location and guide treatment planning. Histopathological confirmation of prostate cancer was obtained in all but one patient.
Treatment Protocol
The electrochemotherapy procedure was performed using a standardized clinical protocol with the Cliniporator® system (IGEA SpA, Italy). It is a minimally invasive, image-guided treatment designed to precisely target tumour tissue.
- The procedure was performed under general anesthesia with the patient in the lithotomy position, and the pelvic area was disinfected and prepared.
- Transrectal ultrasound imaging guided the procedure and confirmed tumour location in alignment with preoperative MRI.
- Physicians inserted 5 to 8 needle electrodes through the perineum under ultrasound guidance, with placement planned to ensure full coverage of the target tumour area.
- A body-surface-adjusted dose of bleomycin was administered intravenously.
- Approximately eight minutes later, electrical pulses were delivered between electrode pairs to induce reversible electroporation, allowing the chemotherapy to enter tumour cells more effectively.
- Electrodes were repositioned as needed to ensure complete coverage of the tumour volume.
- After treatment, the electrodes were removed, and patients were monitored overnight before discharge the following day.
Follow-Up Protocol
Patients were monitored after treatment to evaluate safety, treatment response, and potential recurrence through a structured follow-up program with PSA testing, MRI, and clinical assessment of urinary and sexual function.
PSA testing was performed every three months during the first two years and every six months thereafter. MRI was conducted one day after treatment, followed by scans at three and nine months, and then annually.
Follow-up included ongoing assessment of:
- Safety and procedure-related effects
Acute toxicity was assessed during and immediately after the procedure until removal of the bladder catheter. MRI performed within 24 hours confirmed alignment between the treatment field and tumour area and evaluated potential procedure-related effects such as hemorrhage or rectal injury. - Urinary function and continence
Urinary symptoms and continence were evaluated using the International Prostate Symptom Score (IPSS) and the International Consultation on Incontinence Questionnaire (ICIQ-UI) before treatment and during follow-up. - Erectile function
Erectile function was assessed using the International Index of Erectile Function (IIEF-5) questionnaire before treatment and during follow-up.
Treatment response and potential recurrence were evaluated using imaging and PSA measurements over time. MRI scans three months after treatment assessed tumour response according to RECIST criteria, where a complete response indicated disappearance of the treated lesion and a partial response indicated at least a 30% reduction in tumour size.
If PSA levels or MRI findings suggested recurrence, additional imaging with PSMA-PET/CT and, when appropriate, confirmatory biopsy were used to evaluate disease progression.
Suspected recurrences were reviewed by a multidisciplinary team of urologists, oncologists, and radiologists to determine further management. In cases where biopsy was declined, PSMA-PET/CT was used alongside MRI for local and whole-body restaging.
Clinical Outcomes
Procedure and Treatment Delivery
Electrochemotherapy was successfully performed in all 144 patients, resulting in a 100% technical success rate.
Treatment coverage included the entire prostate in most patients, with tumour volume extending beyond the capsule in 133 patients (93%). Partial or palliative treatment was performed in a small number of cases.
The mean procedure duration was 106 ± 26 minutes. Treatments used an average of seven electrodes (range 5–8), and the average intravenous bleomycin dose was 29 ± 1 mg.
Safety and Adverse Events
| Adverse Event | Patients | Percentage |
| Intraprostatic edema | 21 | 14.5% |
| Anterior rectal wall irritation | 5 | 3.4% |
| Severe complications | 0 | 0% |
No severe complications were reported. Observed adverse events were limited and primarily included intraprostatic edema and minor rectal wall irritation.
Functional Outcomes
| Outcome | Result |
| Urinary continence | Preserved in all previously continent patients |
| Severe incontinence | Improved in affected patients |
| Severe erectile dysfunction (overall) | 6% (9 patients) |
| Persistent severe ED (>1 year) | 0.7% (1 patient) |
Urinary continence was preserved in all previously continent patients, and severe incontinence improved in those affected prior to treatment.
More than half of patients had impaired erectile function before treatment, reflecting the advanced disease profile of the cohort.
Short-Term Tumour Response (3 Months)
| Response Category | Patients | Percentage |
| Complete response | 88 | 75% |
| Partial response | 21 | 18% |
| Stable disease | 6 | 5% |
| Disease progression | 2 | 2% |
At three months, 75% of patients achieved a complete response, with data available for 117 patients (81% of the cohort). Response was evaluated using PSA measurements confirmed by MRI.
Treatment response was significantly associated with tumour stage, Gleason score, and PSA levels before treatment.
Disease Progression
| Outcome | Patients | Percentage |
| Local recurrence | 11 | 8% |
| Systemic progression | 5 | 3% |
| Local and systemic progression | 2 | 1% |
| Total progression | 18 | 13% |
During follow-up, 13% of patients experienced disease progression. The average time to progression was 15 ± 6 months.
Progression-Free Survival
| Metric | Outcome |
| 1-year progression-free survival | 88% (95% CI: 80–97%) |
| 1-year local progression-free survival | 92% (95% CI: 84–99%) |
One-year progression-free survival reached 88%, with local progression-free survival at 92%. Outcomes were significantly associated with tumour stage and PSA levels before treatment, but not with Gleason score.
Outcomes in Lower-Risk Patients
| Patient Group | Complete Response |
| Gleason score 6–7a | 98% |
| PSA < 10 ng/ml | 94% |
| T1–T2 tumors | 92% |
Outcomes were strongest in patients with earlier-stage disease, including those with lower Gleason scores, lower PSA levels, and organ-confined tumours.
Complete response rates reached up to 98% in patients with Gleason scores of 6–7a, 94% in patients with PSA levels below 10 ng/ml, and 92% in patients with T1–T2 tumours. One-year progression-free survival reached 100% in patients with T1–T2 tumours and 96% in those with Gleason scores of 6–7a.
These findings are consistent with broader oncology outcomes, where earlier-stage disease is generally associated with higher response rates, while still demonstrating effectiveness across a heterogeneous patient population.
Study Limitations
Several limitations should be considered when interpreting these findings:
- Functional outcome data available for a subset of patients only
- Retrospective study design
- Heterogeneous patient population across disease stages
- Relatively short follow-up period
- Long-term survival outcomes are not yet available
Conclusion
This retrospective analysis demonstrates that electrochemotherapy can be safely and feasibly performed in patients with prostate cancer, with high technical success and encouraging tumour control.
Treatment was well tolerated, with low observed toxicity and preservation of key functional outcomes, including urinary continence and erectile function in most patients.
While longer follow-up and prospective studies are needed, these findings provide early clinical evidence supporting electrochemotherapy as a potential focal therapy option in prostate cancer.
About Vitus Privatklinik
Vitus Privatklinik is a Germany-based private clinic specializing in minimally invasive, organ-preserving cancer treatments, with a focus on electroporation-based therapies such as irreversible electroporation (IRE) and electrochemotherapy (ECT).
The clinic has treated more than 2,000 patients using electroporation techniques and has contributed to multiple clinical publications evaluating their use in prostate cancer.
Its work forms part of an ongoing clinical program focused on advancing electroporation-based therapies in prostate cancer treatment.
- Stevanovic M, Heringer M, Hjouj M, Zanasi A, de 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.
- Klein N, Gunther E, Zapf S, El-Idrissi R, Atta J, Stehling M. Prostate cancer infiltrating the bladder sphincter successfully treated with Electrochemotherapy: a case report. Clin Case Rep. 2017;5(12):2127-2132. Published 2017 Nov 13. doi:10.1002/ccr3.1270.