Transurethral ultrasound ablation: low functional morbidity, uncertain long-term cancer control

Design

Systematic review and meta-analysis of 12 studies

Population

630 patients with prostate cancer treated with TULSA (89% primary)

Primary outcome

12-month recurrence-free survival, pad-free continence, erectile function

Effect

RFS 70% (95% CI 50 to 84) primary; continence 90% (71 to 97); erectile function 81% (56 to 94)

This systematic review and meta-analysis pooled 12 studies with 630 patients who had MRI-guided transurethral ultrasound ablation (TULSA), most (89%) as primary treatment. Primary outcomes were 12-month biopsy-proven clinically significant cancer recurrence-free survival, pad-free continence and preserved erectile function.

Pooled 12-month recurrence-free survival was 70% (95% CI 50 to 84) after primary treatment and 80% (66 to 89) after salvage treatment. It was 75% for whole-gland and 71% for focal ablation. Pad-free continence was 90% (71 to 97), erectile function was preserved in 81% (56 to 94) and grade 3 adverse events occurred in 6% (4 to 11). Results varied widely between studies, reflecting different endpoints, techniques and follow-up.

The authors judge primary treatment safe with low functional morbidity, but long-term cancer control is unproven and technique remains experimental. Salvage data are sparse and preliminary reports suggest relatively high incontinence. Counsel men that one-year recurrence-free rates of 70% leave a substantial minority needing further treatment.

• Discuss ablation as an option with limited follow-up, not as equivalent to surgery or radiotherapy.
• Quote the 12-month recurrence-free figure of about 70% with its wide interval.
• Counsel that continence and erectile function were mostly preserved but varied between studies.
• Plan MRI and biopsy follow-up at defined intervals.
• Be cautious with salvage TULSA, where incontinence rates appeared higher.

Why it matters

Men worry most about continence and erections, and this offers pooled figures for both while showing what is still unknown about cancer control.

Don't overread it

Twelve mostly single-arm studies with one-year endpoints cannot show that TULSA controls cancer as well as standard treatments.

The statistics, in plain English

A pooled recurrence-free rate of 70% with a 95% interval of 50% to 84% means the true figure could plausibly be anywhere in that range, mainly because studies differed. Short follow-up means recurrence beyond a year is not captured.

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