Transurethral Ultrasound Ablation a Promising Prostate Cancer Treatment

TULSA is a promising prostate cancer treatment that effectively targets tumors while minimizing side effects and preserving healthy tissue.

Patients with prostate cancer demonstrated reduced tumor volume and PSA levels, a key marker of prostate cancer progression, and experienced improved urinary function and maintained sexual function after undergoing Transurethral Ultrasound Ablation (TULSA), according to a study presented at the CURE® Educated Patient® Prostate Cancer Summit by Dr. Yair Lotan, a professor of urology at UT Southwestern Medical Center in Dallas.

Five-year data from the study TACT showed that among patients, 63% of whom had intermediate risk disease post-surgery at baseline, 80% of patients experienced no significant disease after one year and 21% of patients underwent additional intervention for prostate cancer five years after receiving TULSA.

Regarding side effects, 8% of patients experienced urinary flow issues requiring an outlet procedure, 2% had urethral stricture requiring treatment, one patient had a fistula from rectum to bladder and one patient with fistula to pubic bone. Lotan mentions that the risk of erectile dysfunction is generally low (10% to 20%), especially when the cancer is distant from the nerves controlling sexual function. However, if the treatment area extends to both sides of the prostate, the risk may increase.

Patient-reported outcomes showed that prior to TULSA, 38% of patients considered themselves to have erectile dysfunction, whereas post-TULSA, 56% of patients considered themselves to have erectile dysfunction. After TULSA, 83% of patients were still able to have penetrative intercourse. When asked if the patient considers themselves incontinent, 84% of patients reported no and 16% reported yes. 

Nine percent of patients wore a pad and 6% sometimes wore a pad. In some cases, particularly when the cancer extends to the apex of the prostate, there may be a risk of incontinence.

Lotan pointed out during his talk at the summit that in the past, patients only had two options for prostate cancer: radical therapy or active surveillance.

“So, what about a third option, a middle ground of sorts of focal therapy? And I think that's something that you know a lot of patients are considering now, and a lot of physicians have various different options [on] in terms of just treating the cancer itself and not treating the rest of the prostate,” Lotan said.

TULSA is a type of focal therapy performed on an outpatient basis that aims to target only the cancerous portion of the prostate, preserving healthy tissue. It combines MRI imaging and thermography with transurethral high intensity ultrasonic energy to precisely ablate (remove or destroy) prostate tissue. This targeted approach offers a more patient-friendly alternative for men with prostate cancer.

The procedure involves inserting a specialized device into the urethra, which is then guided to the cancerous area using MRI imaging. Treatment typically takes two to three hours.

During the presentation, Lotan discussed each step during the procedure. First, doctors use MRI images to pinpoint the tumor and plan the treatment. Then, they use focused ultrasound energy to heat and destroy the tumor while preserving surrounding healthy tissue. This process takes about 30 to 60 minutes and is carefully monitored throughout the procedure to ensure that only the targeted tissue is affected.

Lotan continued, discussing patients who are not suited for TULSA treatment. Individuals who may not be ideal candidates include those with calcification and metal implants, which can prevent heat from reaching tissue beyond the calcification, or past hip replacements, which can block the view of the full prostate. Other treatment options include follow-up for active surveillance, surgery, radiation and other ablation treatments.

Ongoing research, such as the CAPTAIN trial, is evaluating the long-term outcomes of TULSA and comparing it to traditional prostate cancer treatments. Early findings are promising, suggesting that TULSA may offer a viable alternative for many patients, Lotan concluded.

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