MRI-Guided TULSA Effective at Five Years for Localized Prostate Cancer

MONDAY, March 25, 2024 (HealthDay News) — For the treatment of localized prostate cancer, in-bore, magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) results in favorable outcomes at five years, including durable oncologic control and functional preservation, according to a study presented at the annual meeting of the Society of Interventional Radiology, held from March 23 to 28 in Salt Lake City.

Steven Raman, M.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues evaluated the safety, quality of life, and oncological outcomes at five-year follow-up among 115 men with localized, predominantly intermediate-risk prostate cancer who underwent a single in-bore, MRI-guided TULSA treatment.

The researchers report that median prostate-specific antigen (PSA) decreased from 6.3 to 0.26 ng/mL nadir at year 1, durable to 0.63 ng/mL at five years. Additionally, median prostate volume decreased 92 percent at year 1. Twenty-five men (21.7 percent) received salvage treatment at five years, all without unexpected complications (10 prostatectomy, 11 radiotherapy, three radiation plus androgen deprivation therapy, and one surgery plus radiation). Treatment failure was predicted by PSA at one year (odds ratio, 3.0) and multiparametric MRI (odds ratio, 12.0). Preventable errors identified in a failure analysis included patient selection, calcification size and location, targeting, or misalignment due to intraprocedural swelling/motion. The majority of men at five years recovered pad-free continence (92 percent) and preserved erections sufficient for penetration (87 percent). One in 10 men had grade 3 adverse events, with none experiencing a grade 4 event or rectal injury.

“The success of TULSA represents a revolution in whole-gland treatment for prostate cancer,” Raman said in a statement. “We have more research to do, but if validated, TULSA has the potential to change the standard of care for thousands of men.”

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