ECT (Electrochemotherapy) and IRE (Irreversible Electroporation

[Jurasuje]

Anyone familiar with ECT (Electrochemotherapy) and IRE (Irreversible Electroporation), two new, more gentle methods are available for the local treatment of bone mets when prostate cancer. It is used at the VITUS Prostate Center in Frankfurt, Germany. vitusprostate.com/en/scienc...

[Tall_Allen]

I assume you are contemplating using IRE on specific bone metastases. It will probably relieve pain, but I don't know if it will have to be redone. When used on the prostate, there was often incomplete ablation. Plus it requires full anesthesia with a heart/lung machine. I think it may be most useful where radiation could be dangerous (e.g., the mediastinal area).

[spencoid2 in reply to Tall_Allen]

Is this just for bone mets or lymph nodes as well? I have paratracheal and hylar lymph node mets for which they said radiation is NG.

[Tall_Allen in reply to spencoid2]

I've never seen it used for lymph nodes. But what is the purpose?

[spencoid2 in reply to Tall_Allen]

If the current treatments stops working I was wondering if this might be an option. I have just a few bone mets and mets in two mediastinal lymph nodes too close to heart to irradiate and also not surgical candidates.

[Tall_Allen in reply to spencoid2]

There is no known benefit to eradicating individual metastases, unless they are causing pain.

[spencoid2 in reply to Tall_Allen]

before the current round of ADT (now orchiectomy and aberaterone) my hilar and para tracheal lymph nodes were growing quickly and would have without treatment caused major problems if they continued to double in size at the same rate. it is not a problem now (last scan was a while ago but i assume the growth has stopped) but what if zytiga stops working and the lymph nodes do grow. My favorite dog died of an inoperable mediastinal mass of unknown origin.

[Tall_Allen in reply to spencoid2]

They may be operable or in a place where ablation can remove them (like cryo or HIFU)

[spencoid2 in reply to Tall_Allen]

i was told that surgery would be difficult and risky. not subject to arthroscopic, would be open chest. no reason to do it at this point obviously as they probably have shrunk as PSA dropped but is climbing up again at about 6 month doubling time.

[Startech in reply to spencoid2]

It's also called Nanoknife. The Vitus website and Nanoknife.com should answer all your questions.

[FRTHBST]

I received electrochemotherapy at Vitus in September of 2020. For me it was not a definitive treatment. My PSA was about 20 before treatment and dropped to 3 by December. It then began to rise again and by June the number was 16.

IRE is a focal therapy that uses a high voltage low amperage current and cells in the affected area die because of holes opened in cell walls. With a higher current the holes are so large that the cells aren't able to repair them, with a lower current the holes produced by the electric field are small enough to be repaired. The idea with electrochemotherapy is to use the lower amount of current while at the time of treatment when the cell walls are porous, a chemotherapy agent is introduced. In my case the drug of choice was an old line anti-cancer med, bleomycin.

It was explained to me that I was a candidate for the electrochemotherapy version of IRE because my tumor was large. And this may explain why it was ultimately not successful for me. I think one primary advantage of IRE over other focal therapies is that it is not a therrmal process so that there can be greater preservation of nerves and larger blood vessels in the treated area. As with all focal therapies, IRE might be most effective when tumors are relatively small and definitely confined to the prostate. In some instances it could be a go to choice for individual metastases where radiation is not advised either because of a specific location or amount prior radiation.