Question: What do you get when you cross prostate cancer doctors (urologists) with cancer doctors (oncologists)?

Answer: You get the Society of Urologic Oncology (SUO). Its organization and bylaws had been established in May, 1984 but the founding officers who were elected did not begin their terms until 1985. As described in its history, some of the new organization’s objectives included bringing together “like-minded urologists with special interest in oncology, to fulfill an educational mission in this area, to identify opportunities to participate in research protocols…”

As with all medical societies, annual meetings bring opportunities to present the latest research to peers such as clinical urologists, radiation and medical oncologists, surgeons and fellow scientists. The SUO’s 24th Annual Meeting (Washington, D.C., Nov. 28 – Dec. 1) featured an important paper on Transurethral Ultrasound Ablation of the Prostate (TULSA-PRO), a customizable treatment for localized prostate cancer that does not involve incisions or radiation. Because the ultrasound tissue destruction is delivered via the urethra (urination passage from the bladder through the prostate to the penis) it’s often called an inside-out ablation method. When the treatment is planned, guided, monitored, and confirmed by real time 3T MRI, as we offer at the Sperling Prostate Center, it is highly precise.

The mutli-center study presented at the SUO meeting brought good news about TULSA. It reported the results to date of a study called TACT (Pivotal Study of MRI-guided Transurethral Ultrasound Ablation in Patients With Localized Prostate Cancer), which had enrolled 115 patients at 13 international centers.^[i] At baseline, the average enrollee PSA was 6.3 ng/mL, and 72 had greater than or equal to Grade Group (GG) 2 disease.

Results

All patients received whole gland (not focal) ablation, and underwent MRI and 10-core biopsy at 1 year following treatment. Patients were followed for up to 5 years. At 1 year, 85% of patients were free of ≥GG2 disease. At 5 years, 21.7% underwent salvage treatment for recurrence without unexpected complications. (It was noted that treatment failure was linked with 1-year MRI showing visible lesion and/or high PSA. The investigators postulated that treatment failure was caused by undertreatment due to patient selection or targeting error.)

The study concluded, “Effective disease control is durable to 5 years after a single TULSA procedure, with a favorable safety profile. Favorable preservation of genitourinary quality of life is also durable to 5 years.” Of particular interest, the study pointed out that during the study period, the procedure itself has improved. More recent protocols include better screening for prostate calcifications that can interfere with treatment effectiveness, better device positioning strategies, and the ability to increase target temperatures for lesions visible on MRI during the procedure.

 

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Pivotal study of MRI-guided transurethral ultrasound ablation (TULSA) of localized prostate cancer: 5-year follow up. Poster #197 presented Dec. 1 by Scott Eggener, MD at the 24th annual SUO meeting (Washington, DC Nov. 28-Dec. 1). https://suo-abstracts.secure-platform.com/a/gallery/rounds/18/details/3269