BackTable / Urology / Podcast / Episode #94
TULSA-PRO: A Practical Guide for Setup and Success
with Dr. Daniel Costa and Dr. Xiaosong Meng
On this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Daniel Costa (UT Southwestern), and Dr. Xiaosong Meng (UT Southwestern) discuss patient selection and procedure for TULSA-PRO, a new transurethral ultrasound ablation system that incorporates real-time MR imaging, as a focal treatment option for prostate cancer.
BackTable, LLC (Producer). (2023, April 26). Ep. 94 – TULSA-PRO: A Practical Guide for Setup and Success [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Daniel Costa
Dr. Daniel Costa is a diagnostic radiologist and an associate professor of radiology at UT Southewstern in Dallas, Texas.
Dr. Xiaosong Meng
Dr. Xiaosong Meng is a urologist and assistant professor with UT Southwestern in Dallas, Texas.
Dr. Aditya Bagrodia
Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.
First, the doctors discuss the benefits of using MRI with transurethral ultrasound ablation (TULSA), which include direct visualization of anatomy, margins, and boundaries. They compare TULSA to other forms of focal management, such as cryoablation, brachytherapy, stereotactic body radiation therapy (SBRT). Compared to these methods, TULSA has lower risk of rectourethral fissures and preserves the posterior plane better, making salvage procedures more viable.
Then, the doctors discuss ideal candidates for TULSA therapy, which include patients with intermediate risk and localized disease, patients with lesions in lateral or anterior portion of prostate, patients with medium sized prostates, low risk patients with lower urinary tract symptoms (LUTS) who do not want to undergo active surveillance. Patients with large calcifications may not be ideal candidates for TULSA, as the calcifications can be a shield for the ultrasound beam. The doctors recommend ordering a CT/MRI scan first to identify if calcifications are present to assess their sizes and locations. During imaging, it is also important to make sure the tumor is not close to key anatomical elements, such as the neurovascular bundle. When deciding between different focal therapies, it is important to balance oncological outcomes and quality of life preservation. Thus, the treatment decision should be a collaboration between patients, their families, the radiologist, and the urologist. The doctors also discuss special considerations for salvage therapy patients, brachytherapy patients, patient with urethral strictures, and patients with a prior history of TURP.
Next, the doctors explain how to prepare patients for TULSA. The patient’s colon has to be emptied in order to reduce MRI noise during the procedure. Additionally, the doctors help patients understand the immediate side effects of the procedure, which can include reduced semen volume, urgency incontinence from bladder and prostate irritation, and temporary erectile dysfunction, and semen retention. After the procedure, the urinary catheter will have to be left inside for five days to two weeks, depending on the volume of the prostate removed. There is a 20-25% chance of recurrence.
Finally, they discuss specifics of the TULSA procedure. Dr. Costa and Dr. Meng perform these procedures at the university hospital, as they need access to MRI and anesthesia. They discuss the optimal MRI window for the procedure, patient positioning, as well as their two sweep method. The total procedure time is dependent on the volume of ablation and number of sweeps, but the average total time is 3 hours. Patients are discharged on the same day, and no narcotics are prescribed. Finally, they discuss the progress of a new prospective multi-center randomized trial comparing focal TULSA therapy to surgery for intermediate risk prostate cancer patients.
[Dr. Xiaosong Meng]
The thing I like best about TULSA Pro is the amount of feedback you get during the treatment. Every 5-6 seconds, you can get a really nice view of exactly what you’re heating and where your margins and boundaries are, which is a different feature than other focal technologies we have out there. I really like the capabilities that TULSA represents.
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