The TULSA-PRO® system is designed to provide customizable and predictable ablation of a surgeon defined region of prostate while actively protecting the urethra and rectum to help preserve the patient’s natural functional abilities.






TULSA Procedure

The word “TULSA” stands for Transurethral Ultrasound Ablation. The TULSA Procedure is a minimally invasive procedure that uses directional ultrasound to produce very high temperatures to ablate targeted prostate tissue. The procedure is performed in a Magnetic Resonance Imaging (MRI) suite and uses the TULSA-PRO® system to ablate prostate tissue. The procedure combines real-time MRI with robotically-driven directional thermal ultrasound to deliver predictable, physician-prescribed ablation of whole-gland or partial prostate tissue.









The role for MRI-guided transurethral ultrasound ablation in the continuum of prostate cancer care


Prostate cancer continues to have a negative impact on the duration and quality of life for males and their families. MRI is transforming the pathway of prostate cancer detection, diagnosis, staging, and surveillance, backed by multiple Level 1 studies and robust reporting standards. This evolving paradigm of MRI-directed care is now being expanded to include in-bore MRI-guided prostate tissue ablation techniques, which reduce the burden of genitourinary complications associated with standard-of-care treatments, without sacrificing cancer control. The workflow for MRI-guided transurethral ultrasound ablation relies on intraprocedural MRI guidance for treatment planning, automated and physician-monitored treatment delivery, and post-treatment assessment at both immediate and long-term time points. Our early experience has identified several procedure refinements, and aligns with early evidence from prospective clinical studies using transurethral ultrasound ablation for treatment of patients with either primary or recurrent disease. Driven by quantitative real-time imaging, MRI-guided ablative interventions provide rich datasets for developing technical refinements and predictive models that will progressively improve patient outcomes as these novel techniques become part of a new standard-of-care.





Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer: A Systematic Review


Purpose: MRI-guided transurethral ultrasound ablation (TULSA) uses real-time MR thermometry feedback to target prostate disease. We systematically review the literature to synthesize efficacy, functional, and safety outcomes and assess the influence of planned ablation fraction on outcome.
Materials and Methods: PubMed, Embase, and the Cochrane Library were searched from inception to June 2021 following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting at least one efficacy, functional, or safety outcome after a single TULSA treatment were included. The relationship of freedom from salvage treatment and potency preservation with planned ablation volume was modeled.
Results: Two hundred twenty-four patients were treated in 10 studies with up to a 5-year follow-up, mainly for primary localized prostate cancer (PCa) plus smaller cohorts with recurrent PCa, and locally advanced PCa (LAPC). The prostate-specific antigen decline from baseline up to 2 years, including focal to whole-gland ablation plans, was 54% to 97%. The rate of salvage treatment after one TULSA treatment for primary PCa was 7% to 17%. Continence and potency preservation were from 92% to 100% and from 75% to 98%. Urinary symptoms were stable in men with good voiding function at baseline, and 85% of men with concurrent PCa and lower urinary tract symptoms met the criteria for improvement. Symptom relief in a small cohort of men with LAPC was observed. Grade III adverse events were incurred by 13/224 men (6%), with no rectal injury/fistula or Grade IV complication. The planned ablation fraction was linearly related to salvage-free survival. The relationship between potency preservation and planned ablation fraction followed a sigmoid curve.
Conclusions: As an alternative to conventional treatments, TULSA is safe and effective for prostate tissue ablation in men with primary PCa. There is also evidence that TULSA delivers effective relief of urinary symptoms while treating PCa in a single, low-morbidity procedure. The likelihood of freedom from additional treatment or potency preservation is associated with the planned ablation fraction.

Keywords: prostate cancer, minimally invasive therapy, MRI-guided therapy, transurethral MRI-guided ultrasound ablation, systematic review