Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer

Figures & data

Table 1. Patient characteristics at baseline.

Parameter	Value
Median age, year (range)	76.5 (60–81)
ECOG performance status, % (n)
1	40% (4)
2	40% (4)
3	20% (2)
Median PSA, ng/mL (range)	18.5 (0.23–140)
Median prostate volume, ng/mL (range)	35 (12–213)
Radiological tumor stage, % (n)
T3	50% (5)
T4	50% (5)
Median CCI (range)	10.5 (5–15)
CRPC, % (n)
Yes	50% (5)
No	50% (5)
Primary cancer treatment, % (n)
ADT	40% (4)
Radiation + ADT	60% (6)
Docetaxel	10% (1)
Continuous catheter, % (n)
Yes	100% (10)
Documented metastatic disease, % (n)
Yes	80% (8)
No	20% (2)
Urinary tract infection, % (n)
Yes	80% (8)
No	20% (2)
pTURP before pTULSA, % (n)
Yes	30% (3)
No	70% (7)
Anticoagulation, % (n)
Yes	40% (4)
No	60% (6)

ECOG: Eastern Cooperative Oncology Group; PSA: prostate-specific antigen; CCI: Charlson comorbidity index; CRPC: castration-resistant prostate cancer; ADT: androgen deprivation therapy; pTURP: palliative transurethral resection of the prostate.

Figure 1. Temporal evolution of catheterization before and after pTULSA.

Table 2. Feasibility of pTULSA.

Catheter-free %, n (n = 10)*
At baseline	Last follow-up
0% (0)	70% (7) catheter-free 10% (1) intermittent catheter
Gross hematuria-free %, n (n = 10)*
At baseline	Last follow-up
10% (1)	100% (10)
Hospitalization days within 6 months, average, range (n = 10)**
Before pTULSA	After pTULSA
7.3 (0–20)	1.4 (0–7)

*until last follow up (6, 9 or 12 months) or to end-of-life; **6 months before and after pTULSA or to end-of-life.

Figure 2. Successful pTULSA case example. Patient presented with radio recurrent castration-resistant LAPCa (rT4N1M1b, GGG5, PSA 19), was continuously catheterized, had a history of recurrent gross hematuria, and the prostatic urothelium line was bleeding from cystoscopy contact. Baseline sagittal MRI image showed obstructive infiltration of PCa to the bladder neck and posterior bladder wall (a). Treatment-day MRI planning images showing the transurethral ultrasound applicator and endorectal cooling device (b and c). 19 cc of tumor around the bladder neck was targeted, with contrast-enhanced MRI revealing immediate effects of ablation (d). Transurethral catheter removal was successful at 1 week, accompanied with a prostate volume increase from 35 to 40 cc on MRI (e). Cystoscopy revealed an open bladder neck at 3 months (f and g). A clear cavity could be seen around the proximal prostatic urethra on MRI, with a corresponding decrease in prostate volume to 12 cc at 12 months (h).