MRI-guided transurethral ultrasound ablation (TULSA) targeted therapy of urinary retention due to benign prostatic obstruction (BPO) and concordant prostate cancer

Introduction & Objectives: The objectives of this study were to evaluate the safety and efficacy of targeted customized (transitional zone plus focal/partial to whole-gland peripheral zone) TULSA as a treatment for patients in urinary retention due to BPO and concordant prostate cancer (PCa). Materials & Methods: The study included men in chronic urinary retention due to BPO and diagnosed with MRI-guided biopsy-confirmed PCa. All men had either transurethral (n=13) or suprapubic (n=4) catheters or intermittant self-catheterization (n=3). Patients underwent TULSA as primary treatment, with Gleason Grade Groups from 1-5. Treatment planning and targeted ablation volume was dependent on individual PCa characteristics, and included the total transitional zone. Treatment was performed under permanent MRI control and temperature mapping. Suprapubic catheters for intermittent drainage were administered in all patients and left in place until sufficient voiding was achieved. Adverse events and surgical complications were reported using the Clavien-Dindo classification. Functional outcomes were reported using IPSS (International Prostate Symptom Score). Short-term oncological control was evaluated using multi-parametric MRI (mpMRI) and prostate specific antigen (PSA). Results: Twenty consecutive patients with a follow-up of 12 months were included. The baseline median age was 76 years (66-87). All patients recovered from urinary retention after a median post-treatment catheterization time of 46 days. 12-months oncological control was achieved in 17 of 20 patients. During follow-up, grade IIIa adverse events were observed in n=5 patients (epidydymitis n=5), with no bowel-related complications. Conclusions: Targeted TULSA appears to offer a good option for men in chronic urinary retention due to BPO with concordant prostate cancer.