Transurethral Ultrasound Ablation for Treatment of Localized Prostate Cancer and Benign Prostatic Hyperplasia (BPH)

Transurethral ultrasound ablation (TULSA) is used for treating localized prostate cancer and benign prostatic hyperplasia (BPH). It's particularly suitable for patients with low to intermediate risk, uni- and multifocal organ-confined prostate carcinomas, symptomatic obstructive BPH coinciding with prostate cancer, and postradiation therapy recurrences. The TULSA procedure involves meticulous preoperative preparation, precise surgical steps, and comprehensive postoperative care. Treatment is performed under magnetic resonance imaging (MRI) guidance using specialized MRI-compatible instruments, including a transurethrally inserted ultrasound applicator and an endorectal cooling device. Ablation is conducted through robot-driven rotation of the applicator, with real-time MRI thermometry used for monitoring and control. A retrospective single-center clinical evaluation involved 300 men with primary localized prostate cancer (PCa) confirmed by biopsy. The median age was 66 years, prostate-specific antigen levels were 6.85 ng/mL, cancer length was 7.6 mm, and prostate volume was 49.2 cc. The median follow-up period was 14 months. Treatments included whole-gland (163 men) and focal TULSA (137 men), with neurovascular bundle sparing in 248 men. Additionally, 88 patients received combined therapy for PCa and BPH. Grade 1 and 2 complications occurred in 57 patients, resolving within 4 weeks. Grade 3 adverse events were seen in seven patients, resolving within 3 months. No grade 4 or higher adverse events and no bowel-related complications were observed. The median international index of erectile function score remained stable from 24 to 25 over 48 months. The international prostate symptom score initially worsened post-treatment but improved to better than baseline levels over 48 months. Pad-free continence was preserved in 96% of patients. Biochemical failure occurred in 26 men, with residual cancer confirmed by biopsy in 14 men. Salvage therapy was required for 14 patients, with 12 patients under active surveillance.