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Relief of lower urinary tract symptoms after MRI-Guided Transurethral Ultrasound Ablation (TULSA) for localized prostate cancer: subgroup analyses in patients with concurrent cancer and benign prostatic hyperplasia

  • Dean Elterman,
  • William Li,
  • Gencay Hatiboglu,
  • James Relle,
  • Kevin C Zorn,
  • Naeem Bhojani,
  • Joseph L Chin

Publication: Journal of Endourology, September 2020

Background

MRI-guided transurethral ultrasound ablation (TULSA) offers minimally-invasive thermal ablation of benign and malignant prostate tissue, using directional high-intensity ultrasound and real-time MR-thermometry feedback control. Feasibility of TULSA for alleviating Lower Urinary Tract Symptoms (LUTS) associated with BPH is retrospectively assessed in a subgroup of men from a localized prostate cancer study who also had LUTS.

Methods

TULSA was used to ablate 90% of the prostate gland in 30 men with localized prostate cancer, without plans to spare ejaculatory ducts. Mean ± SD treatment time was 37±10 minutes. Retrospective analysis was conducted on a subpopulation of 9 patients who also suffered from LUTS (IPSS ≥12 at baseline) as well as a smaller subgroup of 5 patients with IPSS>12 and Qmax <15 ml/s. Urinary symptom relief, continence, and erectile function were assessed using International-Prostate-Symptom-Score (IPSS), International-Index-of-Erectile-Function (IIEF) and uroflowmetry.

Results

At 12 months post-TULSA, IPSS improved significantly by 58% to 6.3±5.0 (p=0.003), with at least a moderate (≥6 points) reduction in 8/9 patients. IPSS Quality of Life improved in 8/9 patients. Erectile function (IIEF-EF) remained stable from 14.6±9.3 at baseline to 15.7±9.0 at 12 months. The proportion of patients with erections sufficient for penetration (IIEF Q2 ≥2) was unchanged. Full urinary continence (pad-free, leak-free) was achieved at 12 months in all patients. In 5 men who suffered from more severe symptoms, Qmax increased from 11.6±2.6ml/s to 22.5±14.2ml/s at 12 months (p=0.126). Perfused prostate volume, measured on MRI, decreased 70% to 13.6±4.6 ml (p=0.003) at 12 months. All adverse events were mild to moderate (CTCAE Grade 1-2) with no serious events reported.

Conclusions

This retrospective analysis demonstrates promising safety and feasibility of TULSA to relieve LUTS, with improvements in IPSS comparable to modern minimally invasive surgical therapies. Larger controlled studies with BPH-specific ablation plans in men seeking treatment for LUTS are warranted.