Written By THT Editorial Team
Reviewed by Dr. Erena Pradhan, Consultant Urologist, MS, MCH
Prostate Cancer:
Prostate cancer is the leading cause of cancer death and the second most common non-cutaneous cancer in males worldwide which is a significant health concern (Abudoubari et al., 2023). Wang et al. (2022) found in their study on global prostate cancer incidence and mortality that a total of 1 414 259 new cases of prostate cancer and 375 304 related deaths were reported in 2020 globally. There are marked variations in the rate of prostate cancer in different populations worldwide which suggests its genetic predisposition (Tzelepi et al, 2022). Apart from that, age, family history, ethnicity, and tobacco smoking are additional risk factors (Berenguer et al.2023). Most of the prostate cancers identified currently are asymptomatic. Diagnosis in these cases is based on elevated prostate-specific antigen (PSA) level, digital rectal examination (DRE), and prostate biopsy. Localized and advanced diseases can cause urinary retention, blood in the urine (hematuria), blood in semen, and pelvic discomfort, back pain, weight loss (Peters et al.2023)
Recent Advances in Prostate Cancer:
The treatment landscape for prostate cancer has seen remarkable progress in recent years. Standard treatment for localized prostate cancer includes active surveillance, radical prostatectomy, and radiation therapy with or without hormonal therapy. New therapies targeting the disease’s resistance to conventional treatments are emerging. One such advancement is a therapy that combines an experimental drug, AZD5069, with enzalutamide, a hormone therapy, showing promising results in shrinking tumors and reducing PSA levels (Guo et al.2023). Another breakthrough is the development of 177 Lu-PSMA-617, a targeted radioligand therapy that delivers radiation directly to cancer cells, demonstrating effectiveness in controlling advanced prostate cancer (Sartor et al.2021)
The TULSA-Pro Procedure:
TULSA-Pro stands for Transurethral Ultrasound Ablation. It is one of the focal ablative therapies for localized prostate cancer which is minimally invasive, providing proper oncological outcome with preserving urinary continence and erectile dysfunction due to nerve sparing.
Procedure:
TULSA procedure is performed in 1.5 Tesla MRI with the patient under general anesthesia. An ultrasound applicator is placed in the prostatic urethra to deliver the focused waves to ablate the cancerous tissue sparing the healthy tissue and a rectal cooling device is placed adjacent to the prostate. Both devices are irrigated with water for thermal protection of the rectum and urethra. MRI shows real-time visual monitoring during the procedure. (Klotz et al.2021)
Post-Procedure Recovery:
Patients can be discharged the same day or can be admitted overnight. They benefit from shorter recovery times and fewer side effects like urinary incontinence and erectile dysfunction.
Clinical Evidence and Results Recent studies highlight TULSA-Pro’s effectiveness:
PSA Reduction: Studies report 75% decrease in PSA levels post-procedure, indicating effective tumor ablation (Peters et al.2023)
Preservation of Erectile Function: TULSA-Pro has been shown to minimize damage to neurovascular bundles, reducing the incidence of erectile dysfunction. (Klotz et al.2021)
Urinary Continence: Patients experience lower urinary leakage rates than traditional surgical treatments (Peters et al.2023).
Quality of life: IPSS urinary symptom score, quality of life score, and voiding/storage sub scores recovered to baseline 3 months post-procedure. Urinary continence and sexual function also recovered to baseline earlier than other measures ( Klotz et al.2021).
Advancements and Future Directions: The TULSA-Pro procedure is evolving, with advancements enhancing its precision and outcomes.
Conclusion
TULSA is a minimally invasive procedure that uses planar ultrasound energy with real-time MRI-based treatment planning, thermal dosimetry, and closed-loop temperature feedback for effective prostate cancer ablation. It signifies a new era in prostate cancer treatment ongoing research promises to refine this innovative approach, broadening its adoption and benefiting patients and healthcare providers globally.
REFERENCES
- Abudoubari, S., Bu, K., Mei, Y., Maimaitiyiming, A., An, H., & Tao, N. (2023). Prostate cancer epidemiology and prognostic factors in the United States. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1142976
- Wang, L., Lu, B., He, M., Wang, Y., Wang, Z., & Du, L. (2022). Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019. Frontiers in Public Health, 10, 811044. https://doi.org/10.3389/fpubh.2022.811044
- Tzelepi V. Prostate Cancer: Pathophysiology, Pathology and Therapy. Cancers (Basel). 2022 Dec 31;15(1):281. doi: 10.3390/cancers15010281. PMID: 36612276; PMCID: PMC9818719.
- Berenguer, C. V., Pereira, F., Câmara, J. S., & Pereira, J. A. M. (2023). Underlying Features of Prostate Cancer-Statistics, Risk Factors, and Emerging Methods for Its Diagnosis. Current Oncology, 30(2), 2300-2321. https://doi.org/10.3390/curroncol30020178 this is for no .2
- Peters, I., Hensen, B., Glandorf, J., et al. (2023). “First experiences using transurethral ultrasound ablation (TULSA) as a promising focal approach to treat localized prostate cancer: a monocentric study.” BMC Urology, 23, Article number: 1421
- Guo, C., Sharp, A., Gurel, B., et al. (2023). Targeting myeloid chemotaxis to reverse prostate cancer therapy resistance. Nature, 623, 1053–1061. https://doi.org/10.1038/s41586-023-06696-z
- Sartor, O., de Bono, J., Chi, K. N., Fizazi, K., Herrmann, K., Rahbar, K., Tagawa, S. T., & the VISION Investigators. (2021). Lutetium-177–PSMA-617 for Metastatic Castration-Resistant Prostate Cancer. The New England Journal of Medicine, 385(12), 1091-1103. https://doi.org/10.1056/NEJMoa2107322
- Klotz, L., Pavlovich, C.P., Chin, J., Hatiboglu, G., Koch, M., Penson, D., Raman, S., Oto, A., Fütterer, J., Serrallach, M., Relle, J., Lotan, Y., Heidenreich, A., Bonekamp, D., Haider, M., Tirkes, T., Arora, S., Macura, K.J., Costa, D.N., Persigehl, T., Pantuck, A.J., Bomers, J., Burtnyk, M., Staruch, R., & Eggener, S. (2021). Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer. Journal of Urology, 205, 769–779. https://doi.org/10.1097/ju.0000000000001362
- Feigl, G. C., Heckl, S., Kullmann, M., Filip, Z., Decker, K., Klein, J., Ernemann, U., Tatagiba, M., Velnar, T., & Ritz, R. (2019). Review of first clinical experiences with a 1.5 Tesla ceiling-mounted moveable intraoperative MRI system in Europe. Bosnian Journal of Basic Medical Sciences, 19(1), 24-30. https://doi.org/10.17305/bjbms.2018.3777