Pulsed Electrical Field Treatment of Prostate Cancer: Benjamin Schurhamer, MD

Benjamin Schurhamer, MD, Assistant Professor of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, explains the differences between traditional irreversible electroporation and pulsed electrical field (PEF) ablation, also known as high-frequency irreversible electroporation. Conventional irreversible electroporation (IRE) uses monophasic waveforms delivered between paired electrodes, whereas PEF uses a biphasic waveform through a single monopolar electrode. Delivering energy in very short high frequency packets reduces electrical spread to nerves and muscle, minimizing fasciculation. He shares procedural videos showing that patients under monitored anesthesia exhibit little visible muscle activation during energy delivery.

Dr. Schurhamer reviews the nonthermal mechanism of PEF. High voltage high frequency pulses destabilize cell membranes producing cell death, while preserving the extracellular matrix and sparing adjacent structures. Slides show a consistent ablation zone and preserved surrounding anatomy.

He summarizes INCITE-ES, a trial for early stage lung cancer, in which PEF created a predictable one centimeter ablation zone with malignant tissue reduction and greater than 95% viability of sensitive structures. Immunohistochemistry demonstrated tertiary lymphoid structures around the ablated region, indicating an immune response. Models further showed a release of damage associated molecules, recruitment of antigen presenting cells, T cell activation, and improved local and distant control, particularly when combined with immune checkpoint inhibitors.

He discusses the IRE IMMUNO study which reported reduced regulatory T cells, increased cytotoxic T cells, and antibody responses to prostate specific antigens after irreversible electroporation. A nonrandomized Chinese PEF trial demonstrated ten to fifteen percent in-field recurrence rates at six months, similar to early irreversible electroporation trials.

He then presents early experience at the University of Pennsylvania. Thirty three patients underwent PEF, twenty-nine as primary therapy and four as salvage therapy. Adverse events included urinary retention, dysuria, hematuria, occasional infections, and epididymitis without serious complications such as fistula formation. Pathology revealed tertiary lymphoid structures adjacent to ablation sites, supporting an immune-mediated component.

Dr. Schurhamer emphasizes that PEF appears safe under monitored anesthesia, produces consistent ablation, and demonstrates signals of immune activation, though oncologic outcomes require further follow-up.

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