Ultrasound with MRI improves prostate treatment: Combining ultrasound heat with precision MRI promises a more precise way to treat prostate cancer and enlarged prostates — without the usual side effects.

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Ultrasound with MRI improves prostate treatment

5-6 minutes

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MRI-guided transurethral ultrasound ablation (TULSA) is a new tool for the highly
accurate treatment of prostate cancer — without the usual side effects.

Ultrasound scans guided by real time MRI may improve prostate cancer treatment.

Prostate cancer is the second leading cause of cancer death among males.

Although the 5 year survival rate with early detection and nonaggressive forms is 99%, 1 in 9 males will receive a diagnosis of prostate cancer at some point in their lives.

Currently, there are two common treatment options: surgical removal of the prostate and radiation therapy.

Although these are usually effective, they come with side effects, including incontinence, erectile dysfunction, and bowel issues. Now, however, researchers have devised a new and promising procedure utilizing therapeutic ultrasound guided by real time MRI.

The researchers have recently presented their method at the Radiological Society of North America conference in Chicago, IL.

TULSA offers enhanced precision and control in the treatment of both prostate cancer and enlarged prostate.

About the prostate

The prostate
is an apricot-sized muscular gland that introduces prostatic fluid to
the seminal vesicles at orgasm. This fluid protects sperm and enhances
their mobility. Some of its compontents include enzymes, zinc, and
citric acid.

Nerve tissues and muscle surround the prostate. This makes it quite difficult to precisely remove or target with radiation.

Although
scientists have investigated other ultrasound systems, TULSA's
employment of real time MRI promises greater accuracy than previously
possible.

How does TULSA work?

The TULSA system has
evolved over the past few years as a minimally invasive approach that
can precisely target prostate tissue without adversely affecting nearby
healthy tissue and muscle.

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The procedure takes place during an MRI scan. This allows doctors to see what they are doing in exceptional detail.

The
rod-shaped TULSA tool contains 10 ultrasound generators that apply
heat. These can destroy, or ablate, prostate tissue. The doctor can
control the individual ultrasound beams using software that continually
optimizes their shape, strength, and targeting.

According to study
co-author Steven S. Raman, "Unlike with other ultrasound systems on the
market, [we] can monitor the ultrasound ablation process in real time
and get immediate MRI feedback of the thermal dose and efficacy."

In
the study, treatment times with TULSA averaged 51 minutes. The
researchers treated the entire prostate in that time. "It's an
outpatient procedure with minimal recovery time," says Raman.

The
trials also validate the use of MRI as a post-TULSA diagnostic tool,
since it proved 93–96% accurate in detecting the absence of cancer at 1
year checkups.

The results of TULSA tests

For the
TULSA-PRO ablation clinical trial, the researchers recruited 115 males.
The participants had a median age of 65 and a low or intermediate risk
of nonmetastasized prostate cancer.

TULSA led to dramatic
improvements in prostate size, from 39 cubic centimeters (cc) to 3.8 cc
at 1 year after treatment. In 80% of the participants, the method
eliminated clinically significant cancer.

Of the final cohort of
111 males, 72 (65%) were cancer-free in biopsies that health
professionals conducted a year later. Their levels of prostate-specific
antigen — which indicate the presence or absence of prostate cancer —
dropped by an average of 95%.

Raman adds that there was "a
dramatic reduction of over 90% in prostate volume and low rates of
impotence with almost no incontinence."

Going forward

Officials
in Europe have already approved TULSA, and Raman is hopeful that
approval in the United States will follow if further testing confirms
the study's findings.

If so, TULSA could become a valuable tool for prostate issues in two ways.

"There are two very unique things about this system," points out Raman.

"First,
you can control with much more finesse where you're going to treat,
preserving continence and sexual function. Second, you can do this for
both diffuse and localized prostate cancer and benign diseases,
including benign hyperplasia."

Steven S. Raman

With
prostate cancer and enlarged prostate being such common occurrences,
TULSA's improved efficacy with fewer side effects will provide a welcome
alternative.