TULSA preserved function well, but a quarter or more still had significant cancer at a year

Design

Systematic review and meta-analysis of 12 studies

Population

630 men treated with TULSA (89% primary, 9% salvage)

Primary outcome

12-month biopsy-proven significant cancer recurrence-free survival; continence; erectile function

Effect

Primary RFS 70% (95% CI 50–84%); pad-free 90%; erections preserved 81%; grade 3 events 6%

This systematic review pooled 12 studies of 630 men treated with MRI-guided transurethral ultrasound ablation (TULSA), most as primary treatment and a minority after radiotherapy failure.

At 12 months, about 70% of men treated primarily were free of biopsy-proven clinically significant cancer, and about 80% after salvage treatment. Whole-gland and focal ablation gave similar results. Function was well preserved: about 90% were pad-free and 81% kept erections. Serious adverse events occurred in about 6%. Salvage treatment carried more incontinence.

The trade-off is clear: good function, but cancer control that is short-term, imprecise and below what surgery or radiotherapy achieve. Confidence intervals are wide and long-term data are lacking.

TULSA remains a treatment for trials and carefully selected patients who understand the uncertainty. It is not established as an alternative to standard radical treatment, and its availability in India is very limited.

• Offer TULSA only within trials or registries, or to selected men after full counselling.
• Tell patients that about 3 in 10 still had significant cancer on biopsy at 12 months.
• Plan follow-up MRI and biopsy after ablation.
• Warn about higher incontinence risk with salvage TULSA after radiotherapy.

Why it matters

Patients increasingly ask about ablation; the honest answer is better function but less proven cancer control.

Don't overread it

Mostly small, uncontrolled series with one-year outcomes; long-term oncological control is unknown.

The statistics, in plain English

The 70% recurrence-free figure has an interval from 50% to 84%, so the true rate is very uncertain. Twelve months is too short to judge survival benefit.

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