- Design
- Systematic review and meta-analysis
- Population
- 630 men in 12 studies (89% primary, 9% salvage TULSA)
- Primary outcome
- 12-month biopsy-proven significant cancer-free survival; continence and erectile function
- Effect
- Primary RFS 70% (95% CI 50 to 84); pad-free 90%; erectile function 81%
MRI-guided transurethral ultrasound ablation (TULSA) heats the prostate from inside the urethra under real-time thermometry. A BJU International meta-analysis pooled 12 studies with 630 men, most having primary treatment (89%) and some salvage (9%).
At 12 months, 70% (95% CI 50 to 84) of men treated primarily were free of biopsy-proven significant cancer, and 80% after salvage. Whole-gland and focal ablation gave similar figures (75% and 71%). Pad-free continence was 90% and erectile function was preserved in 81%. Grade 3 adverse events occurred in 6%.
The wide intervals and heterogeneity reflect varied definitions and follow-up. Functional outcomes look favourable, but 12-month cancer control in about seven in ten is modest, and long-term data are missing. Salvage TULSA data are thin and early series report more incontinence.
- About 70% of men had no significant cancer on biopsy a year after primary TULSA.
- Continence (90%) and erectile function (81%) were well preserved overall.
- Long-term oncological outcomes are not yet known.
- Counsel men that TULSA trades better function for less certain cancer control than radical treatment.
- Salvage TULSA carries a higher incontinence risk in early series.
Why it matters
Men choosing ablation need to hear that a fifth to a third may still have significant cancer at one year.
Don't overread it
Pooled small studies with heterogeneous definitions cannot establish long-term cancer control.
The statistics, in plain English
A confidence interval of 50% to 84% around 70% means the true one-year cancer-free rate could plausibly be as low as half.
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