Focal Therapy


With focal therapy the treatment of prostate cancer is focussed only on the cancer region within the prostate. Thereby the aim is to spare healthy prostate tissue and surrounding nerves in order to preserve urinary continence and erectile function while still treating the cancerous region.

This new treatment paradigm was developed as a response to complications seen after whole-gland treatment (treating the entire prostate) like surgery or radiotherapy. In order to be a candidate for a focal treatment, prostate cancer needs to be confined to one localized region within the prostate and be of intermediate aggressiveness.

Different techniques can be used to focally ‘ablate’ (treat) prostate cancer (freezing, laser, focussed ultrasound (heating) or electricity. We used irreversible electroporation as ablative modality, in which the tumour is killed by high-voltage electrical shocks between needles that surround the tumour. Our research line contains multiple projects on selection the appropriate patient for focal therapy, evaluation the outcomes of focal therapy and is looking to improve the outcomes and selection for this new modality.

What we’ve done so far

First of all we looked at how to select the appropriate patient and found that a combination of the use of MRI and template biopsies (that is to take multiple prostate biopsies out of every region within the prostate) was able to selection patients accurately (Tran et al., 2016). This was followed by our first trials on the use of irreversible electroporation in prostate cancer (Blazevski, Scheltema, et al., 2020; Blazevski, Scheltema, Yuen, & Masand, 2019; Ting et al., 2016; Valerio et al., 2014; van den Bos et al., 2017). Our latest publication showed that we are able to clear the prostate cancer in roughly 95% whilst still being able to treat the other 5% with surgery or radiotherapy. 99% of patients preserved their urinary continence and 76% preserved their erectile function (Blazevski et al., 2019). Other studies showed that it’s safe to treat anywhere within the prostate (Blazevski, Amin, et al., 2020; Scheltema et al., 2018) and that surgery after focal therapy is still a good treatment option (Blazevski et al, 2022).

Ongoing projects

As we found that the MRI after focal therapy is less reliable as normal (Scheltema, Chang, et al., 2017), we are looking to improve the diagnostic options after focal therapy. This may be done with PET CT scanning (PSMA) or by looking more closely to changes in the tissue on biopsies after focal therapy (an area that’s called (epi)genetics). We are also still treating patients with irreversible electroporation and are monitoring them to get a more mature insight in the outcomes of this new treatment. Moreso, we expanded the treatment to patients that have a localized recurrence after radiotherapy within their prostate (without the presence of metastasis) (Scheltema, van den Bos, et al., 2017).

Future directions

Our aim is to establish this new treatment option as a valid treatment option for men with localized prostate cancer due to the low risk of side effects and the effectiveness we see. In order to succeed we must improve our patient selection (truly finding those with only one region of prostate cancer within their prostate) and be able to rule out any remaining cancer after the treatment. One other area that may be explored is the evolving world of immunology. In other types of cancer is has been shown that the immune system is able to recognise cancer better after is has been ablated. Potentially the combination between an ablation and immunotherapy could be the way forward for certain types of prostate cancer.

Our Publications on Focal Therapy

Valerio, M, Stricker PD, H. U. Ahmed, L. Dickinson, L. Ponsky, Shnier R, C. Allen, and M. Emberton. 2014. Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer. Prostate Cancer Prostatic Dis, 17: 343
Ting F, M. Tran, M. Böhm, Siriwardana A, van Leeuwen PJ, Haynes AM, Delprado W, Shnier R, and Stricker PD. 2015. Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control. Prostate Cancer And Prostatic Diseases, 19: 46.
Ting F, van Leeuwen PJ, and Stricker PD. 2016. Step-by-Step Technique for Irreversible Electroporation of Focal Prostate Cancer: An Instructional Video Guide. J Vasc Interv Radiol, 27: 568.
Scheltema M.J, van den Bos W, Siriwardana AR, Kalsbeek AMF, Thompson JE, Ting F, Bohm M, Haynes AM, Shnier R, Delprado W, and Stricker PD. 2017. Feasibility and safety of focal irreversible electroporation as salvage treatment for localized radio-recurrent prostate cancer. BJU Int, 120 Suppl 3: 51-58.
Scheltema MJ, Chang JI, Bohm M, van den Bos W, A. Blazevski, Gielchinsky I, Kalsbeek AMF, van Leeuwen PJ, Nguyen TV T. M. de Reijke, Siriwardana AR, Thompson JE, J. J. de la Rosette, and Stricker PD. 2018. Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy. World J Urol.
Van den Bos W, Scheltema MJ, Siriwardana AR, Kalsbeek AMF, Thompson JE, Ting F, Bohm M, Haynes AM, Shnier R, Delprado W, and Stricker PD. 2018. Focal irreversible electroporation as primary treatment for localized prostate cancer. BJU Int, 121: 716-24.
Scheltema MJ, Chang JI, van den Bos W, Gielchinsky I, Nguyen TV T. M. Reijke, Siriwardana AR, Bohm M, J. J. de la Rosette, and Stricker PD. 2018. Impact on genitourinary function and quality of life following focal irreversible electroporation of different prostate segments. Diagn Interv Radiol, 24: 268-75.
Scheltema M.J, T. J. O'Brien, van den Bos W, D. M. de Bruin, R. V. Davalos, C. W. M. van den Geld, M. P. Laguna, R. E. Neal, 2nd, I. M. Varkarakis, A. Skolarikos, Stricker PD, T. M. de Reijke, C. B. Arena and J. de la Rosette (2019). umerical simulation modeling of the irreversible electroporation treatment zone for focal therapy of prostate cancer, correlation with whole-mount pathology and T2-weighted MRI sequences. Ther Adv Urol 11: 1756287219852305.
Blazevski, A, Scheltema MJ, A. Amin, Thompson JE, N. Lawrentschuk and Stricker PD (2019). rreversible electroporation (IRE): a narrative review of the development of IRE from the laboratory to a prostate cancer treatment. BJU Int.
Blazevski A, Scheltema MJ, Yuen B Masand N, Nguyen TV W.Delprado, Shnier R, A. Haynes, Cusick T, Thompson J, Stricker P. Oncological and Quality-of-life Outcomes Following Focal Irreversible Electroporation as Primary Treatment for Localised Prostate Cancer: A Biopsy-monitored Prospective Cohort. Eur Urol. Oncol(2019).
Blazevski, A, Scheltema MJ, A. Amin, Thompson JE, N. Lawrentschuk and Stricker PD (2020). Irreversible electroporation (IRE): a narrative review of the development of IRE from the laboratory to a prostate cancer treatment. BJU Int 125(3): 369-378.
Blazevski A, Amin A, Scheltema MJ, Balakrishnan A, Haynes AM, Barreto D, Cusick T, Thompson J, Stricker PD. Focal ablation of apical prostate cancer lesions with irreversible electroporation (IRE). World J Urol. 2021 Apr;39(4):1107-1114.  Epub 2020 Jun 2.
Blazevski A, Gondoputro W, Scheltema MJ, Amin A, Geboers B, Barreto D, Haynes AM, Shnier R, Delprado W, Agrawal S, Thompson JE, Stricker PD. Salvage robot-assisted radical prostatectomy following focal ablation with irreversible electroporation: feasibility, oncological and functional outcomes. BMC Urol. 2022 Mar 2;22(1):28.
Geboers B, Gondoputro W, Thompson JE, Reesink DJ, van Riel LAMJG, Zhang D, Blazevski A, Doan P, Agrawal S, Matthews J, Haynes AM, Liu Z, Delprado W, Shnier R, de Reijke TM, Lawrentschuk N, Stijns PEF, Yaxley JW, Scheltema MJ, Stricker PD. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Irreversible Electroporation-A Multicenter Validation Study. Eur Urol Focus. 2022 May 13:S2405-4569(22)00106-7. Epub ahead of print.
van Riel LAMJG, Geboers B, Kabaktepe E, Blazevski A, Reesink DJ, Stijns P, Stricker PD, Casanova J, Dominguez-Escrig JL, de Reijke TM, Scheltema MJ, Oddens JR. Outcomes of salvage radical prostatectomy after initial irreversible electroporation treatment for recurrent prostate cancer. BJU Int. 2022 Apr 27. Epub ahead of print.
Ong S, Chen K, Grummet J, Yaxley J, Scheltema MJ, Stricker P, Tay KJ, Lawrentschuk N. Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus? BJU Int. 2022 Sep 9. Epub ahead of print.
Scheltema M.J, Geboers, B, Blazevski, A, Doan, P, Katelaris, A, Agrawal, S, Barreto, D, Shnier, R, Delprado, W, Thompson, J. E, & Stricker, P. D. (2022). Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer. BJU international, 10.1111/bju.15946. Advance online publication.
Blazevski, A, Geboers, B, Scheltema M.J, Gondoputro, W, Doan, P, Katelaris, A, Agrawal, S, Baretto, D, Matthews, J, Haynes, A. M, Delprado, W, Shnier, R, Van den Bos W, Thompson, J. E, Lawrentschuk, N, & Stricker, P. D. (2022). Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial. BJU international, 10.1111/bju.15947. Advance online publication.
Geboers, B, Scheltema M.J, Blazevski, A, Katelaris, A, Doan, P, Ali, I, Agrawal, S, Barreto, D, Matthews, J, Haynes, A. M, Delprado, W, Shnier, R, Thompson, J. E, & Stricker, P. D. (2023). Median 4-year outcomes of salvage irreversible electroporation for localized radio-recurrent prostate cancer. BJU international, 10.1111/bju.15948. Advance online publication.
Emberton M, Reijke T;, Stricker P, Miñana, Bianco F, Dominguez Escrig J, Lantz A, Sanchez-Salas R. Revisiting Delphi to create a basis for the future of focal therapy for prostate cancer. Urology Journal URL-D-23-00730
Lantz A, Nordlund P, Falagario U, Jäderling F, Özbek O, Clements M, Discacciati A, Grönberg H, Eklund M, Stricker P, Emberton M, Aly M, Nordström T. Prostate Cancer IRE Study (PRIS): A Randomized Controlled Trial Comparing Focal Therapy to Radical Treatment in Localized Prostate Cancer. Eur Urol Open Sci. 2023 Apr 8;51:89-94. . PMID: 37091033; PMCID: PMC10114162.
Deivasigamani S, Kotamarti S, Rastinehad AR, et al. Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement. Eur Urol. 2023;84(6):547-560. Epub ahead of print. PMID: 37419773.
Scheltema MJ, Katelaris A, Stricker PD. Salvage irreversible electroporation for radio-recurrent prostate cancer. Nat Rev Urol. 2023 Mar 1. . Epub ahead of print. PMID: 36859611.
Rodríguez-Sánchez L, Emberton M, de Reijke T, Stricker P, Miñana B, Bianco F, Escrig JLD, Lantz A, Sanchez-Salas R. Revisiting Delphi to Create a Basis for the Future of Focal Therapy for Prostate Cancer. World J Mens Health. 2023 Oct 16. DOI: 10.5534/wjmh.230160. Epub ahead of print. PMID: 37853538.
Zhang K, Stricker P, Löhr M, Stehling M, Suberville M, Cussenot O, Lunelli L, Ng CF, Teoh J, Laguna P, de la Rosette J. A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer.  Prostate cancer and prostatic diseases. 2024 Jan 9.”. Epub ahead of print. PMID: 38195916.
Geboers B, Meijer D, Counter W, et al. Prostate-specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy. BJU Int. 2024;133 Suppl 4:14-22. https://doi:10.1111/bju.16207
Williams ISC, Katelaris A, Geboers B, Doan P, Delprado W, Scheltema MJ, Stricker P. Transrectal Ultrasound as Real-Time Confirmation of Adequate Needle Positioning During Irreversible Electroporation in Focal Therapy of Prostate Cancer. Videourology 37, pp. 1 - 2
Geboers B, Scheltema MJ, Jung J, Stricker PD. Irreversible Electroporation of Intermediate risk prostate cancer mitigates immune suppression and induces systemic antitumor T cell activation Presented at USANZ Annual Scientific Meeting 2024

Ongoing projects

  • Focal Irreversible Electroporation as salvage treatment in radio-recurrent prostate cancer: A prospective multi-centre trial (FIRE trial)
  • Oncological and quality of life outcomes following focal irreversible electroporation (NanoKnife) as primary treatment for localised prostate cancer
  • Immunomodulatory effects following focal ablation of localized prostate cancer with irreversible electroporation (NanoKnife)
  • Multicentre Validation of Diagnostic Accuracy of MRI post Focal Therapy with Irreversible Electroporation (IRE)
  • Clinical utility DNA methylation assays as predictive biomarkers of treatment failure/success in focal therapy (NanoKnife)
  • Evaluate accuracy of PSMA PET, MRI and Biopsy – a retrospective analysis, identify lobes with significant prostate cancer and their role in selecting patients for hemi-ablative focal therapy (NanoKnife)
  • Salvage robot-assisted radical prostatectomy after focal ablation with irreversible electroporation: feasibility, oncological and functional outcomes (Multi-Centre)