Magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) has emerged as a promising treatment option for localized prostate cancer (PCa). This study reports our institutional experience with TULSA, focusing on initial disease status and follow-up imaging and pathology outcomes. Conducted as a single-center study, we prospectively collected data from men with localized PCa who underwent TULSA as their primary treatment. Prior to the procedure, all patients were evaluated with prostate MRI and biopsy, allowing for individualized treatment plans based on disease characteristics and patient preferences. Follow-up included routine PSA measurements every three months, along with repeat prostate MRI and biopsy at one year.
From October 2020 to June 2023, 126 patients underwent TULSA as the primary treatment for PCa. At the one-year mark post-TULSA, there was a significant reduction in PSA levels, with a median decrease of 72.1% (IQR 56.3-92.1%, p<0.0001). Among the patients, prostate volume decreased by 51.4% (IQR 26.2-68.9%), and median PSA density dropped by 49.9% (IQR 14.1-86.6%). In the follow-up imaging, 28.6% of patients exhibited focal lesions. Of the 63 patients who underwent follow-up biopsies, 14 were found to have PCa recurrences, comprising 1 Gleason Grade (GG) 3, 6 GG2, 4 GG1, and 3 ungraded cases due to treatment effects. Notably, only 6.3% of men required salvage treatment after one year, indicating promising primary treatment efficacy in our initial TULSA experience, with many patients opting for active surveillance after negative follow-ups.
