Women's & Men's Health

Session: Educational Exhibit Presentations - Station 12: Women's & Men's Health

MRI-Guided Transurethral Ultrasound Ablation (TULSA) of Prostate: Initial Experience at WellSpan Health

Monday, March 6, 2023

5:15 PM – 5:20 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Adnaan Moin, MD (he/him/his)

Interventional Radiologist
WellSpan Health

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

ES

Edward Steiner, MD, FACR

Chief, Advanced Prostate Care Center
WellSpan Health
NS

Nathan Soucier, n/a

Engineering & Clinical Scientist
Profound Medical
GP

Gena Paul, CRNP

CRNP
WellSpan Health

Disclosure(s):

Adnaan Moin, MD: No financial relationships to disclose

Learning Objectives: Transurethral Ultrasound Ablation (TULSA) is a minimally-invasive MRI-guided thermal ablation method used for targeted treatment of prostate tissue. This educational exhibit covers the basics of the TULSA technology and devices, ideal patient population, procedural workflow, and summary of early oncological and functional outcomes.

Background: TULSA uses directional ultrasound to ablate a physician-defined region of the prostate while actively protecting the urethra, urinary sphincter, and rectum. In patients with prostate cancer, TULSA combines real-time MRI and robotically-driven ultrasound, to achieve comparable disease control to radiation therapy or prostatectomy. While TULSA has been primarily investigated for localized prostate cancer, men with symptomatic benign prostatic hyperplasia can benefit from a combination treatment where the transition zone is targeted to alleviate lower urinary tract symptoms. Given the transurethral approach with continuous cooling of urethra and rectum, TULSA uniquely provides a favorable safety profile when treating patients with radiorecurrent disease.

Clinical Findings/Procedure Details: The TULSA procedure follows a patient-centered approach where the planned ablation fraction (focal to whole gland) is defined based on the disease characteristic and anatomical structures that can be preserved (ejaculatory ducts, neurovascular bundles, sphincters, etc.). During patient screening it is important to rule out extra-prostatic disease based on PSMA-PET, large ( > 3 mm) calcifications obstructing the intended ultrasound beam path, and targets beyond 3cm from the urethra. WellSpan Health has treated 25 patients since March 2021 with follow-up appointments at 3, 6, 9, and 12-months post-procedure with 12-months being the optimal time for evaluation with MRI. Pad-free continence was maintained by all patients. All patients potent at baseline (n=13) regained potency by the 9-month follow-up visit. Median (IQR) PSA decreased from 5.9 (5.1 - 6.8) ng/mL to 0.2 (0.1 – 1.8) ng/mL at 3 months, and no patient experienced biochemical recurrence (Phoenix criteria).

Conclusion and/or Teaching Points: The precise treatment control offered by TULSA results in a safe and effective option for men with localized prostate cancer with promising oncological outcomes. Critical lessons and teaching points include patient preparation, considerations on treating radio-recurrent disease, tissue, and workup of patients with intermediate to high grade lesions with PSMA scans. Early functional, oncological and safety outcomes are reported as well as preliminary tumor recurrence data.