Introduction:

Focal therapy for prostate cancer provides an attractive option for patients interested in balancing treatment related side effects on urinary and erectile function with oncologic control. MR-guided transurethral ultrasound ablation (TULSA) has emerged as a focal therapy technique for localized prostate cancer that may be able to achieve acceptable oncologic outcomes while maximizing functional outcomes important to patients. Here we share patient-reported outcomes after TULSA, including satisfaction and treatment regret metrics.

Methods:

We conducted a retrospective survey of men currently enrolled in a single-center, prospective study utilizing TULSA to treat localized prostate cancer. The survey was sent via patient portal to those treated with TULSA between October 2020 and December 2023. Surveys contained 4 sections based on validated questionnaires, including questions regarding urinary and erectile symptoms and feelings of satisfaction and regret. Each section contained dynamic questions that collected further information depending on patient responses. Survey responses were analyzed. Patients were then grouped into regret and non-regret cohorts based on responses to the prompt “I regret the choice that was made.” Those who answered “disagree” and “strongly disagree” were grouped into the non-regret cohort and all others were assigned to the regret cohort. Those who selected any option other than “strongly disagree” were prompted to quantify the extent that 10 symptoms contributed to their inability to select “strongly disagree.”

Results:

In total, 162 surveys were sent, and 83 surveys were fully completed and subsequently analyzed. Most (89.2%) patients agreed or strongly agreed TULSA was the right decision, they would choose TULSA again (84.3%), and they would recommend TULSA to family (88.0%). Responding to the prompt “I regret the choice that was made,” patients reported: strong disagreement 56 (67.5%), disagreement 17 (20.5%), neutrality 5 (6.0%), agreement 3 (3.6%), and strong agreement 2 (2.4%). As a result, 10 patients were assigned to the regret cohort. Compared to the non-regret cohort, those in the regret cohort were significantly more likely to endorse worst postoperative erections compared to preoperative erections and were less likely to have erections with self-stimulation (Figure 1). A distribution of the 10 symptoms contributing to patient sentiment is shown in Figure 2. Erectile dysfunction (88.9%) and ejaculatory issues (70.4%) were the most cited reasons for not selecting “strongly disagree.”

Conclusion:

Our findings identify a significant relationship between post-TULSA decision regret and erectile function. Our data shows that overall satisfaction with TULSA is high and functional outcomes may be more favorable than radical treatment options. However, our findings also support that variability in outcomes may significantly impact patient-reported treatment regret. Further work is needed to identify the relationships between patient selection, intraoperative techniques and functional outcomes to further refine which patient populations may experience the best functional outcomes and the highest treatment satisfaction after TULSA.

Funding: Dedman's Scholar