Introduction:

Magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) has emerged as a new option for treatment of localized prostate cancer (PCa). Here we report on our institutional experience with the TULSA procedure regarding oncologic outcomes, including initial disease status, follow-up PSA, imaging, and pathology from our cohort. 

Methods:

This is a single-center study of prospectively collected data of men with localized PCa who underwent TULSA as primary treatment of their disease. All men were evaluated with prostate MRI and prostate biopsy prior to treatment. Men with prior PCa therapy were excluded. Treatment plans were individualized based on disease characteristics and patient preference, spanning lesion specific to whole gland. Oncologic outcomes were followed at routine intervals with PSA evaluation every 3 months and repeat prostate MRI and biopsy at 1 year, followed by annual prostate MRI and PSAs every 6 months after year 1. Primary treatment efficacy was defined as the number of men after 1-year imaging/biopsy follow-up who underwent salvage treatment. 

Results:

From 10/2020-12/2023, 152 patients underwent TULSA for PCa treatment. Patient characteristics are listed in Table 1. At 1-year, median PSA decreased by 78.8%(IQR 56.3-92.1%). Of the 129 patients with 1-year follow-up, 78%(101/129) of patients underwent follow-up MRI. Prostate volume decreased by 57.8%(IQR 34.3-81.5%) and median PSA density decreased by 53.3%(IQR 20.7-76.4%). On 1-year MRI, 24/101(23.7%) patients had focal lesions on imaging (1 PIRADS-5, 13 PIRADS-4, 8 PIRADS≤3, 2 indeterminate PIRADS). 41/101(40.6%) patients refused 1-year biopsy given favorable MRI and PSA values. 60/101 (59.4%) patients underwent repeat systematic plus targeted biopsy at 1 year; 18/60(30%) with PCa recurrences, 17/18 were the same or lower Gleason Group (GG) compared to initial biopsy (Table 2). 7/101(6.9%) men with 1-year follow-up have undergone salvage treatment (3 repeat TULSA, 2 RALP, 2 XRT). Median time to salvage treatment was 512 days. 

Conclusion:

Our experience with TULSA demonstrates significant decreases in post procedure PSA, PSA density and prostate volume. Approximately 41% (41/101) of patients refused 1-year follow up biopsy after a negative MRI and favorable PSA trend. We found a recurrence rate of 30% (18/60) on 1 year biopsy, with 44.4% (8/18) of patients having ≥ GG2 disease and 94.4% (17/18) of patients with stable or lower GG compared to initial biopsy. Of all men reaching at least 1-year post-TULSA follow up, 6.9% have undergone salvage treatment. 

Funding: Dedman's Scholar