A Closer Look at MRI-Guided Transurethral Ultrasound Ablation for Intermediate Risk Prostate Cancer

Overtreatment of patients with prostate cancer has been a significant issue and may have impacted between one to two million men with the disease, suggested Steven Raman, M.D., in a recent interview.

However, the emergence of magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) appears to be a promising option for men with intermediate risk prostate cancer (PCa), a treatment that has a more favorable side effect profile than surgery and radiation, according to Dr. Raman, a professor of radiology, urology and surgery at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

In research presented at the recent Society of Interventional Radiology (SIR) conference, Dr. Raman noted the use of MRI-guided TULSA led to a 92 percent reduction in median prostate volume (from 37.3 ml to 2.8 ml) and a 48 percent reduction in the presence of Gleason Grade (GG) 2 PCa at one year.

At five years after treatment with MRI-guided TULSA, Dr. Raman and colleagues found that 87 percent of patients had preserved erectile function and 92 percent had recovered pad-free continence.

Dr. Raman says the use of MRI guidance and thermometry are more advantageous than prior ultrasound monitoring of thermal ultrasound treatments and key to the success of the TULSA procedure.

“What I don’t like about (ultrasound monitoring) is you don’t know how hot (it is) getting and where exactly you are treating. With MRI, thermometry is an important tool. MRI images the entire prostate as you’re treating it and while you’re treating it, you’re seeing how hot things get in the prostate and outside the prostate,” explained Dr. Raman. “This is an important safety tool to minimize damage to the nerve, the sphincter, and other things, and that results in much better outcomes.”

(Editor’s note: For related content, see “Emerging Insights on MRI-Guided Transurethral Ultrasound Ablation for Prostate Cancer,” “Can MRI-Guided Transurethral Ultrasound Ablation Have an Impact for Localized Prostate Cancer?” and “Can MRI Findings Help Predict Toxicity After Radiotherapy for Prostate Cancer?”)

For more insights from Dr. Raman, watch the video below.