When tests showed that his early-stage prostate cancer had begun growing more aggressively, Mr Tan Kok Wee faced the prospect of having the whole gland removed — and possible permanent side effects of urinary and sexual dysfunction as a result.

  This was because the cancer, like 40 per cent of men with the disease, was found too near the urethra — within 1mm — and other vital structures for him to undergo more traditional methods of treatment. However, Mr Tan, in his late 60s, was able to undergo a treatment known as irreversible  electroporation, or IRE, which was recently introduced at Singapore General Hospital (SGH).

  “IRE allows us to bring treatment to around and including the urethra area,” said Dr Tay Kae Jack, Senior Consultant, Department of Urology, SGH and National Cancer Centre Singapore (NCCS). “IRE spares all the critical structures around the prostate, such as the erectile function nerves, the urine passage, the rectum, and the bladder. These will be preserved without damage.”

  Mr Tan was only the third patient to  undergo the treatment at SGH. About a month after the procedure, his prostate specific antigen (PSA) level had fallen to 0.11 from 4.1 before surgery. When the PSA, the standard test for prostate cancer, records a reading of more than 4, it is an indication of a high risk of prostate cancer.

  Performed under ultrasound guidance, IRE involves inserting two or more thin probes through the skin between the anus and scrotum to reach the tumour in the prostate. A generator is then connected to the probes, which sends 80 to 90 short electrical pulses to kill the cancer. The electric current causes irreversible pores to form in the cell membrane. These cells will die and be removed from the body via a process called apoptosis, allowing new cells to grow in their place.

  The IRE procedure is performed under general anaesthesia and takes around an hour. In most cases, patients are discharged on the same day. As the prostate will swell for a few days after the procedure, patients will be fitted with a catheter to help them urinate.

  IRE is a form of therapy that precisely targets small prostate cancers for destruction without damaging surrounding structures that govern sexual and urinary function. It is suitable for treating not just cancers near the urethra, but also selected early-stage prostate cancer patients with a tumour not bigger than 1.5cm.

  Being able to offer a wider spectrum of treatments means that SGH is able to customise treatment to the disease, which can be diagnosed at different stages and with cancers of different sizes and locations. Prostate cancer can be treated with surgery to remove the whole gland, radiotherapy, and focal therapy, which uses very high or very low temperatures to kill specific areas of cancerous cells. All these methods, however, risk damaging tissues, nerves and organs around the urethra.

  For instance, focal cryotherapy, which freezes the cancer at -40°C, is more suitable for the outer area of the prostate, but up to half of cancers occur in the central area of the prostate, said Dr Tay. “With focal IRE, there is more comprehensive treatment for cancer in all locations within the prostate to provide personalised care for our patients,” he added.

  Prostate cancer is the leading cancer among men. According to the latest Singapore Cancer Registry numbers, there were about 7,000 newly diagnosed cases of prostate cancer between 2017 and 2021, up from about 5,000, between 2013 and 2017.