Transurethral Ultrasound Ablation for Treatment of Localized Prostate Cancer and Benign Prostatic Hyperplasia (BPH)

<b><i>Indications:</i></b> Transurethral ultrasound ablation (TULSA) is used for treating localized prostate cancer and benign prostatic hyperplasia (BPH). It's particularly suitable for patients with low to intermediate risk, uni- and multifocal organ-confined prostate carcinomas, symptomatic obstructive BPH coinciding with prostate cancer, and postradiation therapy recurrences. <b><i>Technique:</i></b> The TULSA procedure involves meticulous preoperative preparation, precise surgical steps, and comprehensive postoperative care. Treatment is performed under magnetic resonance imaging (MRI) guidance using specialized MRI-compatible instruments, including a transurethrally inserted ultrasound applicator and an endorectal cooling device. Ablation is conducted through robot-driven rotation of the applicator, with real-time MRI thermometry used for monitoring and control. <b><i>Outcomes:</i></b> A retrospective single-center clinical evaluation involved 300 men with primary localized prostate cancer (PCa) confirmed by biopsy. The median age was 66 years, prostate-specific antigen levels were 6.85 ng/mL, cancer length was 7.6 mm, and prostate volume was 49.2 cc. The median follow-up period was 14 months. Treatments included whole-gland (163 men) and focal TULSA (137 men), with neurovascular bundle sparing in 248 men. Additionally, 88 patients received combined therapy for PCa and BPH. <b><i>Safety:</i></b> Grade 1 and 2 complications occurred in 57 patients, resolving within 4 weeks. Grade 3 adverse events were seen in seven patients, resolving within 3 months. No grade 4 or higher adverse events and no bowel-related complications were observed. <b><i>Functional Outcomes:</i></b> The median international index of erectile function score remained stable from 24 to 25 over 48 months. The international prostate symptom score initially worsened post-treatment but improved to better than baseline levels over 48 months. Pad-free continence was preserved in 96% of patients. <b><i>Oncological Outcomes:</i></b> Biochemical failure occurred in 26 men, with residual cancer confirmed by biopsy in 14 men. Salvage therapy was required for 14 patients, with 12 patients under active surveillance.