Christian P. Pavlovich, MD, examines the use of TULSA in prostate cancer treatment, highlighting its technique, outcomes, and future potential.
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James Wysock, MD, MS, delves into the evolving role of whole gland ablation (WGA) in prostate cancer management, particularly in intermediate- to high-risk cases and challenging clinical scenarios.
In this 20-minute presentation, Dr. Wysock highlights specific patient profiles where WGA may be preferable, including those with prior pelvic radiation, contraindications to surgery or radiotherapy, or elderly patients seeking less invasive yet effective treatment. In the salvage setting, WGA offers a compelling alternative for local recurrences, achieving substantial cancer control while avoiding aggressive surgical or radiation options.
Technological advancements like TULSA and HIFU enhance WGA precision. Challenges such as recurrence rates and in-field failures underscore the need for meticulous treatment planning and expanded ablation margins.
Dr. Wysock advocates for trials to validate WGA as a mainstream option, particularly in patients who cannot undergo radical treatments. This approach aligns with evolving guidelines and patient preferences, underscoring WGA’s potential as a transformative option in prostate cancer care.
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Nicole L. Miller, MD, FACS, delivers an incisive update on the surgical management of benign prostatic hyperplasia (BPH). In this 11-minute presentation, Dr. Miller outlines the current AUA guidelines, highlighting a broad spectrum of treatments tailored to prostate size. Trends in national data reveal that transurethral resection of the prostate (TURP) remains the dominant procedure, while minimally invasive options like UroLift have gained substantial traction.
Dr. Miller discusses emerging technologies, including the OptilumeⓇ BPH System. She also reviews promising data on MRI-guided transurethral ultrasound ablation (TULSA). Advanced laser techniques, particularly holmium pulse modulation, and thulium fiber laser, are explored for their efficacy in enucleation procedures, showing advantages in operative time, hemostasis, and same-day discharge rates. Miller highlights evolving techniques like en bloc enucleation with early apical release. A brief discussion on robotic-assisted simple prostatectomy includes recent shifts toward single-port approaches.
Dr. Miller stresses the importance of aligning treatment with patient preferences and quality-of-life goals, emphasizing shared decision-making as central to optimizing outcomes in this rapidly advancing field.
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Xiaosong Meng, MD, PhD, explores the ongoing CAPTAIN trial, a multinational, randomized clinical study comparing transurethral ultrasound ablation (TULSA) with radical prostatectomy in patients with intermediate-risk prostate cancer. The CAPTAIN trial builds on the TACT study, which demonstrated the safety and efficacy of whole-gland ablation using TULSA.
In this 11-minute presentation, Dr. Meng outlines the eligibility criteria for the CAPTAIN trial participants and reviews the study schema. The trial aims to provide level 1 evidence of safety and efficacy, addressing the need for robust comparative studies to support guideline adoption of ablative technologies.
The trial evaluates outcomes including quality of life, urinary continence, erectile function, and long-term efficacy, with follow-up extending to 10 years. The study’s findings are anticipated to substantiate the use of TULSA as an effective and patient-preferred alternative to radical prostatectomy, potentially influencing clinical practice and reimbursement policies.
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Robert Princenthal, MD, describes the transurethral ultrasound ablation (TULSA) procedure, highlighting its flexibility, effectiveness, and histological benefits.
Read MoreLaurence Klotz, MD, Professor of Surgery at the University of Toronto and the Sunnybrook Chair of Prostate Cancer Research, discusses MRI-guided transurethral ultrasound ablation (TULSA) in patients with localized prostate cancer. He characterizes this energy-based therapy as one that meets a need for patients with intermediate-risk prostate cancer, offering a less-invasive therapy with fewer quality-of-life effects than radiation and radical prostatectomy. Dr. Klotz explains the closed-loop controlled system and lays out the TULSA-PRO system components, emphasizing the power of the real-time thermal map when using thermal energy to heat tissue to destroy it. He then outlines the MRI-guided treatment workflow before listing the key features of TULSA: since it is a transurethral directional ultrasound ablation, it is incision- and radiation-free, with no energy being delivered through the rectum (thus avoiding rectal injury) and no volume limitation; the automated, closed-loop system eliminates guesswork and allows for precision, measuring temperature in real time, adjusting the amount of energy delivered to the tissue, and actively compensating for tissue and blood flow changes during the treatment; the therapy also offers thermal protection of important anatomy, including the urethra and rectum. Dr. Klotz then reviews previous TULSA technical and canine studies and the first-in-man treat and resect study for feasibility. This research led to a phase one safety and precision study that showed a 90 percent prostate-specific antigen (PSA) reduction. Dr. Klotz then reviews the TULSA-PRO Ablation Clinical Trial (TACT), which demonstrated a median PSA reduction of 95 percent, with consistent rates of biopsy-based improvement in 75-80% of men one year after TULSA therapy; data also show that TULSA therapy is easily tolerated and that most patients recover continence and erectile function within the year after therapy. Indeed, three-year follow-up data for TACT demonstrate that PSA response has been durable over time. Dr. Klotz concludes with a summary of TULSA, emphasizing the newness of this complex technology that is safe, precise, and has low toxicity. He highlights that it has been approved by the FDA and Health Canada and is emerging as a novel alternative to conventional therapy.
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