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The objectives of this retrospective study were first to evaluate the safety and early-stage efficacy and durability of targeted (focal/partial to whole-gland) TULSA as a treatment for prostate cancer (PCa). For those PCa patients simultaneously presenting with symptomatic and obstructive benign prostatic hyperplasia (BPH), TULSA was also evaluated as a combination therapy. Materials & Methods: The study included men diagnosed with MRI-guided biopsy-confirmed PCa who underwent TULSA as primary or salvage treatment, with Gleason Grade Groups from 1-5. Treatment planning and targeted ablation volume was dependent on individual PCa characteristics, concordant BPH and patient preferences. Treatment was performed under permanent MRI control and temperature mapping. Surgeon-assessed functional outcomes were reported. Early-stage oncological control was evaluated using multi-parametric MRI (mpMRI) and prostate specific antigen (PSA). The Clavien-Dindo classification of surgical complications was used to record adverse events. Repeat treatment was allowed. Results: Fifty-two consecutive patients with a median follow-up of 27 months were included, with a baseline median age of 67 years (63-76) and PSA of 8.0 ng/ml (5.2-13). Median PSA nadir after primary treatment was 1.1 ng/ml (0.51-2.2). In total, 9 patients underwent repeat TULSA. Early-stage treatment success was 73% after initial TULSA and 88% after repeat TULSA. Of the patients who received a combination treatment 83% experienced LUTS symptom improvement. Two Grade IIIa adverse events were observed, with no bowelrelated complications. For continence outcomes, one patient worsened to 1 pad per day. No changes from baseline regarding erectile dysfunction were reported. Treatment results confirmed durable in longer follow-up. Conclusions : Targeted TULSA appears to offer a good compromise between safety and early oncological efficacy, and is a feasible combination therapy for treating concordant BPH.
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