MR-guided focused ultrasound (MRgFUS) and transurethral ultrasound ablation (TULSA) have emerged as MRI-guided, minimally invasive options for men with localized prostate cancer who seek tissue-preserving alternatives to radical therapy. This scoping review mapped and synthesized clinical studies published since 2015 on MRgFUS and TULSA in primary and recurrent disease, focusing on indications, oncologic efficacy, functional outcomes, and safety. A systematic search of PubMed and Scopus identified 34 eligible studies, mostly single-arm series in men with organ-confined, low- to intermediate-risk cancer, with smaller cohorts including high-risk and post-radiotherapy patients. Across whole-gland TULSA series, 12-24‑month biopsy‑negative rates ranged roughly from two thirds to almost all patients, with marked PSA declines, while focal MRgFUS consistently achieved very high in‑field control but showed relevant rates of out‑of‑field recurrence on systematic biopsy in multifocal disease. Urinary continence was generally preserved (pad‑free rates close to 100%), and erectile function was maintained in most men, particularly after focal treatments, clearly outperforming historical radical prostatectomy series in functional terms. Adverse events were predominantly mild and transient, with serious complications concentrated in salvage procedures after radiotherapy. Overall, MRgFUS and TULSA appear safe and effective for carefully selected patients, but heterogeneity of study designs, short follow‑up, and limited comparative data underscore the need for randomized trials and longer-term outcomes to define their precise role in prostate cancer management.
Salvaggio et al. (Wed,) studied this question.
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