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15-03-2024 | Prostate Cancer | Review

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

Authors: Kin Fen Kevin Fung, Roberto Luigi Cazzato, Thibault Tricard, Pierre D. E. Marini, Gregory Bertucci, Pierre-Alexis Autrusseau, Guillaume Koch, Julia Weiss, Julien Garnon, Hervé Lang, Afshin Gangi

Published in: CardioVascular and Interventional Radiology

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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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Literature
1.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
3.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
4.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
5.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
6.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
7.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
8.
10.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
11.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
12.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
13.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
14.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
15.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
16.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
17.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
18.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
20.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
21.
go back to reference Sapareto SA, Dewey WC. Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys. 1984;10(6):787–800.CrossRefPubMed Sapareto SA, Dewey WC. Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys. 1984;10(6):787–800.CrossRefPubMed
22.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
23.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
24.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
25.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
26.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
27.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
28.
go back to reference 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.CrossRef 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.CrossRef
29.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
30.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
31.
go back to reference 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. 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.
32.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
33.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
34.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
35.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
Metadata
Title
MR-Guided Transurethral Ultrasound Ablation (TULSA)—An Emerging Minimally Invasive Treatment Option for Localised Prostate Cancer
Authors
Kin Fen Kevin Fung
Roberto Luigi Cazzato
Thibault Tricard
Pierre D. E. Marini
Gregory Bertucci
Pierre-Alexis Autrusseau
Guillaume Koch
Julia Weiss
Julien Garnon
Hervé Lang
Afshin Gangi
Publication date
15-03-2024
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-024-03696-y