The primary goal of the TULSA procedure is to kill prostate tissue while protecting the surrounding organs and structures and, as much as possible, maintaining the functions of those organs and structures when it comes to potency and continence.

TULSA stands for Transurethral Ultrasound Ablation of the Prostate. Treatment with this procedure is performed under MRI guidance and as such is performed in an MRI examination room and not in an operating theatre.

The TULSA name is actually an acronym for Transurethral Ultrasound Ablation of the Prostate.

Transurethral means “through the urethra”.
This is a natural body entry point, which means the procedure is incision-free.

Ultrasound is sound waves that travel at frequencies higher than the upper range of what a human can hear.
Sound waves can be used to create heat in tissue. The TULSA procedure takes place while the patient lies within an MRI machine, and the doctor can see what is happening during the treatment in real-time, from start to finish. This allows the doctor to create a treatment plan based on each and every patient’s unique needs and closely monitor the treatment with real-time MRI monitoring.

Ablation means the “destroying tissue”.
In the TULSA procedure ultrasound is used to heat tissue to a specific temperature at which cells die. Heating a cancer cell to the point of “cell death” means, it can no longer carry out cell functions. An Ultrasound Applicator, made up of ten transducer elements, is inserted into the urethra under anaesthesia. The transducer elements focus the ultrasound energy to the areas of the prostate the physician has decided to treat.

Alternative therapy for prostate cancer / TULSA

The prostate is treated directly from the inside.
This unique delivery direction means that the ultrasound energy does not have to pass through the rectum, or other important body structures to reach the prostate. This is a key advantage of TULSA because it helps to protect the surrounding healthy tissue and nearby nerves. This also means that the physician can treat larger prostates and also reach 360 degrees of the prostate.

How long is the TULSA procedure?

The TULSA procedure is performed in one single day and does not require multiple sessions as it typical for radiation therapy. The total procedure only takes a few hours and is usually carried out under general anaesthesia.

Once the treatment is finished, the physician may choose to have the patients stay in the hospital overnight for observation or the patient may be able to go home the same day.

What are the potential benefits to the patient?

  • Clinical evidence has shown that most patients who undergo the TULSA procedure maintain their erectile and urinary function; this is not the case for some of the other treatment options.A patients ability to maintain erectile function following the TULSA procedure depends on many factors including how advanced the disease is and/or the cancer stage and localisation of the tumour. The procedure is generally well-tolerated, which means it gives patients the chance to lead a normal, high-quality life after the treatment.
  • The TULSA procedure is minimally invasive. There is no surgical removal of the prostate, instead,it is treated locally (still inside the body) without incisions.
  • The TULSA procedure does not use ionising radiation.
  • Clinical evidence has shown that neighbouring organs such as the rectum are not affected by the TULSA procedure.The system directs the ultrasound energy towards the areas of the prostate the doctor plans to treat, and actively protects the areas not to be treated.
  • The TULSA procedure allows for the treatment to be tailored individually to the patient’s tumour. Depending on whether the tumour is only present in a small part of, in half of or in the entire prostate, it is possible to treat just the affected area.
  • Following a TULSA procedure, the patient is usually discharged from hospital the same day, or the next day dependant on the doctor’s assessment.

What are the main advantages of TULSA?

  • Prostate cancer is not the same in every patient, physicians often refer to it as a “multifocal” disease. Multifocal means that many men will have several smaller tumours that are not as easy to identify with imaging techniques as single large tumours. The TULSA procedure is flexible because a doctor can plan thetreatment to ablate a small part of the prostate (focal therapy) or the entire prostate gland (whole-gland therapy), the decision is made depending on the disease location.
  • Prostate sizes are not the same in every patient. TULSA procedure provides flexibility to treat small (30cc) to very large prostates (100cc). Some ablation procedures require the prostate to be smaller in size prior to ablation and may deem it necessary for the patient to have a transurethral resection of the prostate or TURP (a surgical removal of prostate tissue). TULSA procedure does not require a patient to undergo TURP.
  • TULSA can also be used for prostate enlargement (benign prostatic hyperplasia, BPH), or as a subsequent treatment option for prostate cancer if radiation therapy has shown to be unsuccessful.
  • TULSA is a precise procedure because of the unique combination of ultrasound and MRI technology. During the procedure, MR Images are taken of the patient’s prostate. The doctor then uses these images to determine and precisely plan the treatment. During the procedure, the doctor can adjust the treatment plan using real-time MRI images. The ultrasound can be used to ablate focal to the whole prostate gland. The MRI also provides accurate temperature measurements every few seconds during the procedure. This combination of technology helps to provide gentle, controlled and automated ablation of the prostate with a high degree of precision and safety.
  • TULSA delivers continuous urethral and rectal cooling which protects these sensitive tissues.
  • TULSA uses intelligent robotics to guide ultrasound. The intelligent robotics precisely move the device within the prostate throughout the procedure for three-dimensional control.
  • The TULSA procedure is minimally invasive, so no-incision is required. Most patients recover quickly after TULSA treatment and can return to their normal everyday life after a few days.
Prostate Cancer Therapy / Pain relieving medications

What are the risks I should know about?

As with all medical procedures, there are some risks associated with TULSA. Clinical evidence has demonstrated a well-tolerated side effect profile with minor or no impact on urinary, erectile, and bowel function at 12 months.1

The effectiveness of a TULSA procedure depends on the diagnosis accuracy of a disease stage and location of the disease. There is a risk that prostate cancer may remain if the disease was not fully ablated during the procedure. Treatment with TULSA does not prevent you from undergoing standard of care therapies for your prostate cancer in the future, such as radical prostatectomy (surgery) or radiation therapy.

Please consult with a doctor at a TULSA treatment center to understand if this treatment may be suitable for you and to discuss the risks associated with the procedure.

Studies and Evidence

TULSA has been studied extensively in the pre-clinical setting for well over a decade to determine its efficacy. Below are the two most recent clinical studies on TULSA.

  • The patients treated in this study saw PSA values decreased by 87% following the TULSA procedure, and the levels remained stable throughout the 36-month follow-up period.
  • Prior to the study, 21 of 30 patients treated reported that they had erections sufficient for penetration. 12-months after the study, 20 of 29 patients treated reported erections sufficient for penetration.
  • 12-months after the study, 30 of 30 patients treated were pad-free urinary continent and 29 of 30 patients were pad-free, leak-free urinary continent.

Preserving Erectile Function

Prostate Cancer - Fear of Impotence

Preserving Urinary Continence

Prostate Cancer - Fear of Incontinence
  • TACT is a study of 115 patients that completed enrolment in January 2018.The studies first interim results have recently been published showing the median PSA value reduction by 95% in patients treated.2
  • The follow-up for this study is underway, and statistically reliable data for quality of life is pending.

Where can I find a TULSA treatment centre?

Click here to find a treatment centre.

Which patients may be eligible?

Patients who exhibit a low-to-intermediate risk prostate cancer may benefit from the TULSA procedure.

The TULSA procedure is designed for patients with localised tumours (cancer confined to the prostate) and has been studied in clinical trials in patients with Gleason scores of 6 and 7.

Die Behandlung bei Prostata.

References

  1. Joseph Chin, Michele Billia, James Relle, Matthias Roethke, Ionel Popeneciu, Timur Kuru, Gencay Hatiboglu, Maya Mueller-Wolf, Johann Motsch, Cesare Romagnoli, Zahra Kassam, Christopher Harle, Jason Hafron, Kiran Nandalur, Blaine Chronik, Mathieu Burtnyk, Heinz-Peter Schlemmer, Sacha Pahernik. MAGNETIC RESONANCE IMAGING-GUIDED TRANSURETHRAL ULTRASOUND ABLATION OF PROSTATE TISSUE IN PATIENTS WITH LOCALIZED PROSTATE CANCER: A PROSPECTIVE PHASE 1 CLINICAL TRIAL. European Urology, 70(3), 2016.
  2. Laurence Klotz, David Penson, Joseph Chin, Christian Pavlovich, James Relle, Michael Koch, Gencay Hatiboglu, Aytekin Oto, Jurgen Futterer, Steven Raman, Yair Lotan, Thorsten Persigehl, Axel Heidenreich, Jose Francisco Suarez, Robert Staruch, Mathieu Burtnyk, Alan Pantuck, JP Sedelaarm Sandeep S. Arora, Gregory Zagaja, Temel Tirkes, Katarzyna Macura, David Bonekamp, Masoom Haider, Scott Eggener. LBA20 MRI-GUIDED TRANSURETHRAL ULTRASOUND ABLATION (TULSA) IN PATIENTS WITH LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS OF TACT PIVOTAL STUDY. The Journal of Urology, 199(4):e1077-e1078, 2018.

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