Customized prostate ablation with magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) offers “favorable and promising” early MRI and PSA results for men with prostate cancer, according to German investigators.

The procedure is a feasible combination therapy for patients who have prostate cancer and concurrent benign prostatic hyperplasia (BPH), they concluded.

A team led by Rolf Muschter, MD, of ALTA Klinic in Bielefeld, Germany, studied 52 consecutive patients with localized prostate cancer who underwent TULSA. Of these, 47 had not previously received treatment and 5 underwent salvage therapy for recurrent prostate cancer. Of the 52 patients, 41 (78.8%) underwent partial ablation, whereas the remainder received whole-gland ablation.

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The investigators said they customized ablation volume based on various factors, including location and Gleason score of the primary lesion, presence of secondary lesions, a diagnosis of BPH, and patient preference.

Both prostate cancer and BPH were present in 23 patients in the treatment-naïve group and 1 patient in the salvage therapy group.

The study population had a median baseline PSA level of 8.0 ng/mL and median age of 67 years. The median follow-up duration was 16 months. The investigators defined treatment success as negative multiparametric MRI findings and lack of PSA recurrence.

The early treatment success rate was 88%, Dr Muschter and colleagues reported in Urologic Oncology. The median PSA level following primary treatment was 1.1 ng/mL. A single repeat TULSA was performed in 9 patients. All 37 patients who were potent prior to TULSA maintained erectile potency.

With regard to urinary continence, 1 patient worsened to 1 pad per day. Of the patients who also had BPH, 83% reported improvement in symptoms. Two grade 3a adverse events were observed, with no bowel-related complications.

“This first real-world series of customized prostate ablation using TULSA demonstrated the safety and early efficacy of partial through whole-gland ablation in men with low- to high-risk localized prostate cancer, as well as symptom relief in men with concurrent cancer and BPH,” the authors concluded. “Partial gland ablation with TULSA had a lower rate of complications and better preservation of urinary continence and erectile function than whole-gland TULSA, with similar rates of biochemical and radiologic cancer control.”


Lumiani A, Samun D, Sroka R, Muschter R. Single center retrospective analysis of fifty-two prostate cancer patients with customized MR-guided transurethral ultrasound ablation (TULSA). Urol Oncol. Published online June 16, 2021. doi:10.1016/j.urolonc.2021.04.022