Clinical Outcomes of MRI-guided Transurethral US Ablation (MRI-TULSA) of Localized Prostate Cancer

Take-Away Points

• ■ Major Focus: To evaluate the safety and efficacy of MRI-guided transurethral US ablation (TULSA) using the TULSA-PRO device as a focal therapy in patients with low- to intermediate-risk localized prostate cancer.

• ■ Key Results: MRI-guided TULSA demonstrated a favorable safety profile with no major treatment-related adverse events. However, 12-month follow-up showed clinically significant prostate cancer in 43.5% of patients.

• ■ Impact: MRI-guided TULSA shows promise as a focal therapy for localized prostate cancer, offering a potential alternative to prostatectomy. However, clinically significant prostate cancer occurred in almost half of patients at 12-month follow-up.

Active surveillance is the standard of care for low-risk prostate cancer (grade group 1). Whole-gland therapies, such as radical prostatectomy or radiotherapy, are used for intermediate-risk disease (grade group 2 or 3). Such therapies carry risks of erectile dysfunction and urinary incontinence. MRI-guided TULSA is an emerging focal therapy designed to reduce these complications by selectively ablating tumor tissue while preserving adjacent structures.

This prospective, single-center trial evaluated the safety and efficacy of MRI-guided TULSA using the TULSA-PRO device in 25 patients with low- or intermediate-risk prostate cancer. The ablation system integrates a transurethral US device for energy delivery with 1.5-T pelvic MRI to visualize the target lesion, real-time thermal monitoring, and postablation assessment. Whole-gland TULSA was performed in all patients while sparing the urethra and a 3-mm margin of prostate tissue at the apical sphincter. A 12-month follow-up biopsy showed clinically significant prostate cancer in 43.5% (10 of 23) of patients. Despite this, the safety profile was favorable, with no major treatment-related adverse events.

The authors concluded that MRI-guided TULSA is a promising focal therapy for localized prostate cancer that may reduce treatment-related morbidity compared to prostatectomy. While the procedure was safe, clinically significant prostate cancer occurred in almost 50% of patients at 12-month follow-up, emphasizing the need for long-term surveillance remains necessary to monitor disease recurrence.

Highlighted Article

• Tricard T, Cazzato RL, Schroeder A, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of localized prostate cancer (MRI-TULSA): a prospective trial. J Vasc Interv Radiol 2025:S1051-0443(25)00385-9. doi: https://doi.org/10.1016/j.jvir.2025.05.024.