Prostatectomy, the traditional removal of the prostate gland as a treatment for prostate cancer, can result in permanent complications, including incontinence and impotence. Since most prostate cancer patients live for many years following the procedure, these side effects caused by nerve damage have a significant long-term impact on quality of life. The end of May marked a seminal moment in history for Indiana University School of Medicine. For the first time in Indiana, two patients with low-grade prostate cancer were treated with TULSA-PRO™ MRI-guided transurethral ultrasound (Profound Medical Corp, Mississauga, ON, Canada).
Physicians Michael O. Koch, MD, Temel Tirkes, MD, and Thomas Gardner, MD, are investigators in a clinical trial at IU School of Medicine, one of eight U.S. institutions to offer the new TULSA-PRO™ procedure, which was performed where the imaging technology is housed at Riley Hospital for Children. IU School of Medicine was chosen to take part in the phase II clinical trial because Koch and Gardner were the first physicians to perform ultrasound ablation of the prostate gland in the U.S. This clinical trial is a collaboration between Urology and Radiology departments, pairing world-class imaging technology with surgical precision to take prostate cancer treatment in a new direction.
The TULSA procedure has two advantages over transrectal ultrasound ablation of the prostate, which is performed from behind the prostate gland. The TULSA procedure uses magnetic resonance imaging (MRI) to locate the prostate and to monitor tissue temperatures a new level of precision for prostate ablation. This is delivered via a transurethral device that emits powerful ultrasound energy to heat the prostate tissue while cooling the urethra. Since this energy comes from the urethra outwards there is little to no heat transmission to struvtures outside of the prostate.
The current trend in prostate cancer treatment is to preserve the function of the prostate as much as possible. The precision imaged-guided focused ablation of the prostate with the TULSA procedure may result in better preservation of nerves surrounding the prostate, as well as better quality of life for patients. Traditional prostatectomy is an invasive procedure requiring post-op hospitalization. In addition to potential better long-term patient outcomes, outpatient TULSA-PRO™ treatment may also significantly reduce healthcare expenses by reducing hospital stay and post-operative care. In this clinical trial, patients are only scheduled for outpatient visits after the procedure.
“Everything about ablation therapies including TULSA is very promising,” states Dr. Tirkes, director of Genitourinary Radiology. “The prostate has been ignored for decades—it’s the only organ that is completely removed in cancer treatment, resulting in many complications. TULSA is automated and auto-adjusted, so it’s safer for the patient.” In the future, we will use these procedures to ablate only part of the gland where the tumor was found via targeted biopsies. Dr. Tirkes also states that the end goal of the TULSA research is to be able to perform the procedure on patients with high- and low-grade prostate cancer.
