Irreversible electroporation in prostate cancer: efficacy, tumor immune microenvironment remodeling, and combination immunotherapy-a narrative review.

Background and Objective: Prostate cancer (PCa) endangers male health, with conventional treatments limited by poor efficacy and high complications. Irreversible electroporation (IRE) is a non-thermal ablation technique that may achieve local tumor control and transiently modulate the tumor immune microenvironment (TIME). This narrative review summarizes current clinical evidence on IRE in PCa and discusses its immunomodulatory mechanisms and translational potential. Methods: This narrative review focused on recent advancements of IRE in PCa. Studies published between January 2015 and August 2025 were retrieved using the search terms "irreversible electroporation/NanoKnife + prostate cancer"; high-quality clinical studies and representative preclinical studies were included, while reviews were excluded, with key data extracted. Key Content and Findings: Available clinical evidence suggests that IRE can achieve acceptable short- to mid-term local tumor control with favorable preservation of urinary continence and sexual function in carefully selected patients with low-to intermediate-risk or locally recurrent PCa. Preclinical and limited exploratory clinical data indicate that IRE may induce immunogenic cell death and transiently modulate the TIME, providing a biological rationale for combination strategies with immunotherapy, although robust clinical validation is lacking. Conclusions: IRE represents a promising focal and salvage treatment option for selected PCa patients. Its proposed immunomodulatory effects support further translational research, but IRE-based combination strategies should currently be regarded as experimental and require validation in well-designed prospective studies.