Pd39-03 12-Month Clinical Outcomes of Salvage Transurethral Ultrasound Ablation (S-Tulsa) for the Treatment of Organ-Confined Radio-Recurrent Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (PD39)1 May 2024PD39-03 12-MONTH CLINICAL OUTCOMES OF SALVAGE TRANSURETHRAL ULTRASOUND ABLATION (S-TULSA) FOR THE TREATMENT OF ORGAN-CONFINED RADIO-RECURRENT PROSTATE CANCER Mikael Anttinen, Pouya Doerwald, Pietari Mäkelä, Pertti Nurminen, Heikki Pärssinen, Teija Sainio, Pekka Taimen, Roberto Blanco Sequeiros, and Peter J. Boström Mikael AnttinenMikael Anttinen , Pouya DoerwaldPouya Doerwald , Pietari MäkeläPietari Mäkelä , Pertti NurminenPertti Nurminen , Heikki PärssinenHeikki Pärssinen , Teija SainioTeija Sainio , Pekka TaimenPekka Taimen , Roberto Blanco SequeirosRoberto Blanco Sequeiros , and Peter J. BoströmPeter J. Boström View All Author Informationhttps://doi.org/10.1097/01.JU.0001008924.16121.42.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with radio-recurrent prostate cancer (PCa) have very limited salvage therapy options. MRI-guided transurethral ultrasound ablation (TULSA) is a novel treatment for localized PCa with favorable clinical outcomes. This study reports the 12-month safety and oncological outcomes of salvage TULSA (sTULSA) for men with localized radio-recurrent PCa. METHODS: Men with biopsy-proven localized PCa recurrence after primary radiation therapy were treated in this prospective, single-center, phase 1-2 study (NCT03350529). Multiparametric MRI (mpMRI) and 18-F prostate-specific membrane antigen (PSMA)-1007 PET-CT were used to confirm organ-confined disease. Patients were followed every three months for adverse events (AEs, Clavien-Dindo), quality-of-life (QoL) questionnaires, uroflowmetry, and prostate-specific antigen (PSA). Disease control was evaluated at 12 months by mpMRI, PSMA PET-CT, and prostate biopsy targeting the treatment area plus areas suspicious in imaging. RESULTS: Forty-one men underwent sTULSA (25 whole-gland and 16 focal ablation); one patient withdrew from the study due to frequent follow-up protocol three months after his treatment with undetectable PSA (<0.006 ng/ml). Baseline characteristics included median IQR age 73 69-77, PSA 3.3 ng/ml 2.3-7, and an interval of 11 years 8-13 between RT and sTULSA. Twenty-six men had fiducial markers (23 gold-3 nitinol). 12-month follow-ups are available for 31 men. AEs included two grade 3 events (2J stent and urethral stricture interventions) and 17 grade 2 events (osteitis pubis, UTI, urinary retention, pyelonephritis, urosepsis, hematuria). One patient with castration-resistant PCa experienced a pubo-prostatic fistula and osteitis after sTULSA, treated with prolonged suprapubic catheterization and oral antibiotics. Median PSA at 12 months post-sTULSA was 0.19 ng/ml (IQR 0.07–0.57) and was undetectable (<0.1) in 13 patients. Two patients were diagnosed with biochemical recurrence (PSA≥nadir+2) at 12-mo follow-up, correlating with the extraprostatic disease on imaging. At 12-month MRI and PSMA PET-CT, 28/31 (90%) men had no visible cancer in the prostate, and four patients had seminal vesicle invasion. Biopsy outcomes at one year revealed that 26/30 (87%) were free of any PCa in the treatment region, while four patients had positive out-of-field biopsies. CONCLUSIONS: 12-month clinical outcomes of sTULSA show remarkable oncological outcomes with an acceptable toxicity for treating localized radio-recurrent PCa. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e813 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mikael Anttinen More articles by this author Pouya Doerwald More articles by this author Pietari Mäkelä More articles by this author Pertti Nurminen More articles by this author Heikki Pärssinen More articles by this author Teija Sainio More articles by this author Pekka Taimen More articles by this author Roberto Blanco Sequeiros More articles by this author Peter J. Boström More articles by this author Expand All Advertisement PDF downloadLoading ...