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MR-Guided Transurethral Ultrasound Ablation (TULSA)—An Emerging Minimally Invasive Treatment Option for Localised Prostate Cancer

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Abstract

The optimal treatment strategy for men with localised prostatic cancer of low and intermediate risk is an actively evolving field. It is important to strike a balance between maximal oncological control and minimal treatment-related complications, which helps preserve the patients’ quality of life. MR-guided transurethral ultrasound ablation (TULSA) has emerged as a minimally invasive treatment option for this group of patients. This article aims to provide of a background on TULSA technology, a step-by-step procedural guide of MR-guided TULSA and to summarise the current evidence of TULSA in management of localised prostatic cancer, as well as other potential indications.

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References

  1. Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol. 2020;77(1):38–52.

    Article  PubMed  Google Scholar 

  2. Klotz L. Overdiagnosis in urologic cancer. World J Urol. 2022;40(1):1–8.

    Article  MathSciNet  PubMed  Google Scholar 

  3. Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79(2):243–62.

    Article  CAS  PubMed  Google Scholar 

  4. Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol. 2010;28(1):126–31.

    Article  PubMed  Google Scholar 

  5. Eastham JA, Auffenberg GB, Barocas DA, Chou R, Crispino T, Davis JW, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, Part I: introduction, risk assessment, staging, and risk-based management. J Urol. 2022;208(1):10–8.

    Article  PubMed  Google Scholar 

  6. Deivasigamani S, Kotamarti S, Rastinehad AR, Salas RS, De La Rosette JJMCH, Lepor H, et al. Primary whole-gland ablation for the treatment of clinically localized prostate cancer: a focal therapy society best practice statement. Eur Urol. 2023;84(6):547–60.

    Article  PubMed  Google Scholar 

  7. Hopstaken JS, Bomers JGR, Sedelaar MJP, Valerio M, Fütterer JJ, Rovers MM. An updated systematic review on focal therapy in localized prostate cancer: What has changed over the past 5 years? Eur Urol. 2022;81(1):5–33.

    Article  PubMed  Google Scholar 

  8. Chin YF, Lynn N. Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer. Cureus. 2022;14(6):e26400.

    PubMed  PubMed Central  Google Scholar 

  9. Anttinen M, Blanco Sequeiros R, Boström PJ, Taimen P. Evolving imaging methods of prostate cancer and the emergence of magnetic resonance imaging guided ablation techniques. Front Oncol. 2022. https://doi.org/10.3389/fonc.2022.1043688.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Borges RC, Tourinho-Barbosa RR, Glina S, Macek P, Mombet A, Sanchez-Salas R, et al. Impact of focal versus whole gland ablation for prostate cancer on sexual function and urinary continence. J Urol. 2021;205(1):129–36.

    Article  PubMed  Google Scholar 

  11. Ahmed HU, Dickinson L, Charman S, Weir S, McCartan N, Hindley RG, et al. Focal ablation targeted to the index lesion in multifocal localised prostate cancer: a prospective development study. Eur Urol. 2015;68(6):927–36.

    Article  PubMed  Google Scholar 

  12. Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, et al. Focal HIFU therapy for anterior compared to posterior prostate cancer lesions. World J Urol. 2021;39(4):1115–9.

    Article  PubMed  Google Scholar 

  13. Klotz L, Pavlovich CP, Chin J, Hatiboglu G, Koch M, Penson D, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. J Urol. 2021;205(3):769–79.

    Article  PubMed  Google Scholar 

  14. Sundaram KM, Staruch R, Burtnyk M, Lane JS, Penson DF, Arora SS. MR imaging-guided transurethral ultrasound ablation of localized prostate cancer: preliminary experience from a single center in a prospective, multi-center, single-arm clinical trial. J Vasc Interv Radiol. 2020;31(5):740-746.e4.

    Article  PubMed  Google Scholar 

  15. Chin JL, Billia M, Relle J, Roethke MC, Popeneciu IV, Kuru TH, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective phase 1 clinical trial. Eur Urol. 2016;70(3):447–55.

    Article  PubMed  Google Scholar 

  16. Nair SM, Hatiboglu G, Relle J, Hetou K, Hafron J, Harle C, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. BJU Int. 2021;127(5):544–52.

    Article  CAS  PubMed  Google Scholar 

  17. Peters I, Hensen B, Glandorf J, Gutberlet M, Dohna M, Struckmann S, et al. First experiences using transurethral ultrasound ablation (TULSA) as a promising focal approach to treat localized prostate cancer: a monocentric study. BMC Urol. 2023;23(1):142.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Burtnyk M, Hill T, Cadieux-Pitre H, Welch I. Magnetic resonance image guided transurethral ultrasound prostate ablation: a preclinical safety and feasibility study with 28-day followup. J Urol. 2015;193(5):1669–75.

    Article  PubMed  Google Scholar 

  19. Rieke V, Pauly KB. MR thermometry. J Magn Reson Imaging JMRI. 2008;27(2):376–90.

    Article  PubMed  Google Scholar 

  20. Boyes A, Tang K, Yaffe M, Sugar L, Chopra R, Bronskill M. Prostate tissue analysis immediately following magnetic resonance imaging guided transurethral ultrasound thermal therapy. J Urol. 2007;178(3):1080–5.

    Article  PubMed  Google Scholar 

  21. Sapareto SA, Dewey WC. Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys. 1984;10(6):787–800.

    Article  CAS  PubMed  Google Scholar 

  22. Siddiqui K, Chopra R, Vedula S, Sugar L, Haider M, Boyes A, et al. MRI-guided transurethral ultrasound therapy of the prostate gland using real-time thermal mapping: initial studies. Urology. 2010;76(6):1506–11.

    Article  PubMed  Google Scholar 

  23. Azzouzi AR, Vincendeau S, Barret E, Cicco A, Kleinclauss F, van der Poel HG, et al. Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer (CLIN1001 PCM301): an open-label, phase 3, randomised controlled trial. Lancet Oncol. 2017;18(2):181–91.

    Article  CAS  PubMed  Google Scholar 

  24. Wysock JS, Rapoport E, Hernandez H, Gogaj R, Lepor H. Biopsy assessment of oncologic control 3 years following primary partial gland cryoablation: a prospective cohort study of men with intermediate-risk prostate cancer. J Urol. 2023;210(3):454–64.

    Article  PubMed  Google Scholar 

  25. Schmid FA, Schindele D, Mortezavi A, Spitznagel T, Sulser T, Schostak M, et al. Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: safety outcomes and complications. Urol Oncol. 2020;38(4):225–30.

    Article  CAS  PubMed  Google Scholar 

  26. Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375(15):1415–24.

    Article  PubMed  Google Scholar 

  27. Dora C, Clarke GM, Frey G, Sella D. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer: a systematic review. J Endourol. 2022;36(6):841–54.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Anttinen M, Mäkelä P, Viitala A, Nurminen P, Suomi V, Sainio T, et al. Salvage magnetic resonance imaging–guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. Eur Urol Open Sci. 2020;25(22):79–87.

    Article  Google Scholar 

  29. Anttinen M, Mäkelä P, Nurminen P, Yli-Pietilä E, Suomi V, Sainio T, et al. Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer. Scand J Urol. 2020;54(6):481–6.

    Article  PubMed  Google Scholar 

  30. Elterman D, Li W, Hatiboglu G, Relle J, Zorn KC, Bhojani N, et al. Relief of lower urinary tract symptoms after MRI-guided transurethral ultrasound ablation for localized prostate cancer: subgroup analyses in patients with concurrent cancer and benign prostatic hyperplasia. J Endourol. 2021;35(4):497–505.

    Article  PubMed  Google Scholar 

  31. 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 Semin Orig Investig. 2021;39(12):830.e9-830.e16.

    Google Scholar 

  32. Nair SM, Stern N, Dewar M, Siddiqui K, Smith E, Gomez JA, et al. Salvage open radical prostatectomy for recurrent prostate cancer following MRI-guided transurethral ultrasound ablation (TULSA) of the prostate: feasibility and efficacy. Scand J Urol. 2020;54(3):215–9.

    Article  CAS  PubMed  Google Scholar 

  33. Ghai S, Finelli A, Corr K, Chan R, Jokhu S, Li X, et al. MRI-guided focused ultrasound ablation for localized intermediate-risk prostate cancer: early results of a phase ii trial. Radiology. 2021;298(3):695–703.

    Article  PubMed  Google Scholar 

  34. Ehdaie B, Tempany CM, Holland F, Sjoberg DD, Kibel AS, Trinh QD, et al. MRI-guided focused ultrasound (MRgFUS) focal therapy for intermediate-risk prostate cancer: a phase 2b multicenter study. Lancet Oncol. 2022;23(7):910–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Benitez CM, Steinberg ML, Cao M, Qi XS, Lamb JM, Kishan AU, et al. MRI-guided radiation therapy for prostate cancer: the next frontier in ultrahypofractionation. Cancers. 2023;15(18):4657.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was not supported by any funding.

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Author notes

  1. Kin Fen Kevin Fung and Roberto Luigi Cazzato have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, University of Hong Kong, Hong Kong, Hong Kong

    Kin Fen Kevin Fung

  2. Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France

    Roberto Luigi Cazzato, Pierre D. E. Marini, Gregory Bertucci, Pierre-Alexis Autrusseau, Guillaume Koch, Julia Weiss, Julien Garnon & Afshin Gangi

  3. Department of Urology, University Hospital Strasbourg, Strasbourg, France

    Thibault Tricard & Hervé Lang

  4. Department of Human Anatomy, University of Strasbourg, Strasbourg, France

    Guillaume Koch

  5. Department of Radiology, Hong Kong Children’s Hospital, Hong Kong, Hong Kong

    Kin Fen Kevin Fung

  6. School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Afshin Gangi

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  1. Kin Fen Kevin Fung
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Correspondence to Kin Fen Kevin Fung.

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Fung, K.F.K., Cazzato, R.L., Tricard, T. et al. MR-Guided Transurethral Ultrasound Ablation (TULSA)—An Emerging Minimally Invasive Treatment Option for Localised Prostate Cancer. Cardiovasc Intervent Radiol (2024). https://doi.org/10.1007/s00270-024-03696-y

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