MRI-guided TULSA effective for managing localized prostate cancer

Results of a single-center prospective study suggest that MRI-guided transurethral ultrasound ablation (TULSA) can be an effective option for the treatment of patients with localized prostate cancer, according to a poster presented at the 2023 Society of Urologic Oncology Annual Meeting.¹

The researchers concluded that salvage treatment being required by only 4 (6%) of 63 patients with 1 year of follow-up shows “promising primary treatment efficacy at this early time point in our TULSA experience.”

“Our experience with TULSA demonstrates substantial post-procedure decreases in PSA level, PSA density, and prostate volume,” first author Emily Bochner, MD, a urology resident at UT Southwestern Medical Center, and her co-investigators wrote on their poster.

The single-institution, prospective study included 126 patients with localized prostate cancer who had received TULSA as their primary treatment at UT Southwestern Medical Center between October 2020 and June 2023. Men who had received prior treatment for prostate cancer were excluded from the analysis. Patient follow-up included PSA testing every 3 months and repeat prostate MRI and biopsy at 1 year.

The median patient age was 68.0 years (interquartile rage [IQR], 63.0-72.0). The median PSA at baseline was 6.2 ng/mL (IQR, 4.4-8.9) and the median prostate volume at baseline was 44.0 mL (IQR, 35.0-55.0). On initial biopsy, the Gleason grade group (GG) was GG1 (13.5%), GG2 (65.1%), GG3 (19.0%), or GG4 (2.4%).

At 1 year after TULSA, PSA levels across the population had decreased by 72.1% (IQR, 56.3-92.1; P < .0001).

Half of the study population (63/126 patients) had received a 1-year follow-up MRI at the time of the analysis. The 1-year imaging results in these patients showed that prostate volume had decreased by 51.4% (IQR, 26.2-68.9) and median PSA density had decreased by 49.9% (IQR, 14.1-86.6).

The 1-year MRI results also showed that 28.6% (n = 18) of these patients had “concerning” focal lesions. The location of 12 of these lesions was in field compared to the TULSA ablation area, and the other 6 lesions were out of field. Subsequent biopsy showed that 44% of the concerning lesions detected on MRI were positive for prostate cancer.

Over one-third (36.5%; n = 23/63) of patients who received a 1-year MRI had negative imaging results and subsequently refused to receive a 1-year biopsy.

All of the other 40 patients (63.5%) who had received a 1-year MRI “underwent repeat systemic plus targeted (when applicable) biopsy at 1 year,” Bochner et al wrote on their poster.

The biopsy results for these 40 patients showed that 26 (65%) of these patients were negative for recurrence, while 14 (35%) of these patients had prostate cancer recurrence. The tumors were GG1 for 4 of these patients, GG2 for 6 patients, and GG3 for 1 patient. The tumors for 3 of the patients were ungraded due to treatment effect, the study investigators noted on their poster.

Of the 14 patients with recurrence, 10 (71%) were managed with active surveillance and 4 (29%) received salvage treatment. The salvage treatments consisted of surgery (n = 1), radiation (n = 1), and repeat TULSA (n = 2).

Bochner et al concluded that salvage treatment being required by only 4 (6%) of 63 patients with 1 year of follow-up shows “promising primary treatment efficacy at this early time point in our TULSA experience.”

Reference

1. Bochner E, Balcazar J, Recchimuzzi, et al. MRI guided transurethral ultrasound ablation (TULSA) of localized prostate cancer: single institution experience of treatment efficacy. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 188.