MP73-09: A retrospective clinical service evaluation of lesion-targeted MRI-guided transurethral ultrasound ablation (TULSA) for the treatment of localized prostate cancer
Introduction: MR-guided transurethral ultrasound ablation (TULSA) is a novel minimally-invasive therapy option for the treatment of organ-confined prostate cancer (PCa) through a whole-gland or lesion-targeted approach. TULSA has shown promising safety and oncological outcomes with minimum side-effect on patients urinary, bowel, and sexual functions. The objective of this retrospective single-center study was to perform a clinical service evaluation of lesion-targeted TULSA for patients with localized PCa. Methods: Men with organ-confined PCa (proved by MRI and biopsy) received lesion-targeted TULSA with sparing of sphincter, urethra, and rectum. A customized treatment was planned for every patient based on his expectations and PCa characteristics. For a subset of men with concurrent PCa and benign prostate hyperplasia (BPH), TULSA was applied as a combined therapy. Repeat TULSA was allowed and a suprapubic catheter was used. The Clavien-Dindo stratification was used to assess the frequency and severity of all adverse events (AEs). Mid-term oncological outcomes were evaluated using multi-parametric MRI (mpMRI) and prostate-specific antigen (PSA). Surgeon-assessed functional outcomes were recorded. Results: 180 patients (150 primary and 30 salvage) with median [IQR] age, baseline PSA, and follow-up availability of 67 [63-76], 8.0 ng/ml [5.2-13], and 12-mon (max 48), respectively, were treated. 40 patients experienced Grade 1 and 2 AEs, resolving within 4 weeks using antibiotics or relevant medication. Grade 3 AEs (urinary retention requiring surgical intervention) occurred in two patients, resolving within 3 months. No grade 4 or higher events and no bowel-related complications occurred. 98% of men preserved pad-free continence. 94/94 men, who were previously potent, maintained erectile potency. 85% of men with concurrent BPH and PCa experienced symptom relief. The mid-term oncological success rate was 88%. A single repeat TULSA was performed on 13 patients. Conclusions: Lesion-targeted TULSA is a safe and customizable prostate ablation therapy with promising mid-term oncological outcomes and minimal side-effect profile on patients erectile, bowel, and urinary functions. TULSA offers the flexibility to treat localized prostate cancer in a primary, salvage, or concurrent setting of BPH through a patient-tailored whole-gland or lesion-targeted approach. SOURCE OF Funding: No funding was received.
