A new study presented at the Society of Interventional Radiology (SIR) Annual Scientific Meeting in Salt Lake City, Utah, shows a treatment using a combination of an MRI and transurethral ultrasound ablation (TULSA) is effective for treating prostate cancer. The minimally invasive procedure was successful without surgery or radiation. However, while the ultrasound ablation gives patients a low-risk alternative without the side effects, it does not eliminate the need for more invasive treatments for all cases.
The TULSA procedure involves inserting a small device through the urethra into the prostate, which is guided by MRI. Ten therapeutic ultrasound elements are then positioned precisely within the prostate, with MRI thermometry monitoring tissue heating to protect sensitive nerves.
The procedure, which lasts two to three hours, can be done in an outpatient or inpatient setting under general or spinal anesthesia. This image-guided therapy aims to maximize cancer cell destruction while minimizing damage to the prostate, thereby achieving more precise outcomes during treatment, including local cancer control.
“The success of TULSA represents a revolution in whole-gland treatment for prostate cancer,” lead author of the study Steven S. Raman, MD, from the David Geffen School of Medicine at UCLA, said in a statement. “Prostate cancer is the most common form of cancer in men, affecting one in eight men in their lifetimes. We have more research to do, but if validated, TULSA has the potential to change the standard of care for thousands of men.”
In this prospective observational study, participants experienced significant improvements in reducing cancer presence, prostate size, and prostate-specific antigen (PSA) levels. Follow-up biopsies showed cancer undetectable in 76% of participants one year after TULSA treatment. Further, within one year, median prostate volume decreased by 92%, and PSA levels decreased from 6.3 ng/ml to 0.63 ng/ml at five years.
TULSA also comes with minimal side effects, with 92% of patients regaining continence and 87% preserving erectile function by five years. The study included 115 men across 13 sites in five countries, with 25 men receiving follow-up conventional treatment due to residual or new tumors.
For those in which TULSA was not a success, Raman and his team identified early predictors of failure, including calcifications between the urethra and target prostate cancer, and improved monitoring of prostate swelling, targeting and misalignment, leading to better detection and management of these preventable errors during the procedure.
Raman said the study validates TULSA as a new tool for interventional radiologists to treat prostate cancer, and the results could lead to the technique of ultrasound ablation—combined with an MRI—being used to treat malignant tumors elsewhere in the body, such as the lungs, kidneys and liver.
Research into TULSA’s complete effectiveness, and its other uses, are ongoing in randomized clinical trials, the results of which are not yet available.
Raman’s study on prostate cancer is still awaiting publication.
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