Role of Transurethral Ultrasound Ablation (TULSA) in Prostate Cancer Focal Therapy

Transurethral ultrasound ablation (TULSA) of prostate cancer is an MRI-guided ultrasound ablation technology used in the treatment of localized prostate cancer, with a unique design to deliver therapeutic thermal energy from the urethra. Performed in-bore, TULSA leverages MRI-based treatment planning with real-time tissue temperature mapping, facilitating precise target-boundary control through dynamic monitoring and feedback, ensuring satisfactory ablation of the intended area(s) while sparing vital structures. Current data show promising results for TULSA in both achieving cancer control and minimizing treatment-related side effects. Here, we provide an overview of the patient inclusion and exclusion criteria, preoperative workup, intraoperative workflow, postoperative follow-up, and management of complications. Clinical results from primary and salvage whole gland ablation and preliminary experience with partial or focal ablation are summarized. Clinical experience indicates that TULSA is a valuable addition to the armamentarium for focal ablative therapy of localized prostate cancer.