How to cite: Schurhamer B. “Pulsed Electrical Field Treatment of Prostate Cancer.” Grand Rounds in Urology. October, 2025. Accessed Oct 2026. https://grandroundsinurology.com/pulsed-electrical-field-treatment-of-prostate-cancer/
Summary
Benjamin Schurhamer, MD, MHCI, Assistant Professor of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, explains the differences between traditional irreversible electroporation (IRE) and pulsed electrical field (PEF) ablation, also known as high-frequency IRE. Conventional 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 and 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 IRE. A nonrandomized Chinese PEF trial demonstrated ten to fifteen percent in-field recurrence rates at six months, similar to early IRE 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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ABOUT THE AUTHOR
Benjamin Schurhamer, MD, MCHI, is an Assistant Professor of Surgery at the University of Pennsylvania in Philadelphia. Dr. Schurhamer specializes in minimally invasive surgery, and his research focuses on novel approaches to prostate cancer, kidney cancer, bladder cancer, and kidney stones.
