Introduction & Objectives: The objectives of this study were to evaluate the safety and efficacy of targeted customized (transitional zone plus focal/partial to wholegland peripheral zone) TULSA as a treatment for patients in urinary retention due to BPO and concordant prostate cancer (PCa). Materials & Methods: The study included men in chronic urinary retention due to BPO and diagnosed with MRI-guided biopsy-confirmed PCa. All men had either transurethral (n=13) or suprapubic (n=4) catheters or intermittant selfcatheterization (n=3). Patients underwent TULSA as primary treatment, with Gleason Grade Groups from 1-5. Treatment planning and targeted ablation volume was dependent on individual PCa characteristics, and included the total transitional zone. Treatment was performed under permanent MRI control and temperature mapping. Suprapubic catheters for intermittent drainage were administered in all patients and left in place until sufficient voiding was achieved. Adverse events and surgical complications were reported using the Clavien-Dindo classification. Functional outcomes were reported using IPSS (International Prostate Symptom Score). Short-term oncological control was evaluated using multi-parametric MRI (mpMRI) and prostate specific antigen (PSA). Results: Twenty consecutive patients with a follow-up of 12 months were included. The baseline median age was 76 years (66-87). All patients recovered from urinary retention after a median post-treatment catheterization time of 46 days. 12-months oncological control was achieved in 17 of 20 patients. During follow-up, grade IIIa adverse events were observed in n=5 patients (epidydymitis n=5), with no bowelrelated complications. Conclusions: Targeted TULSA appears to offer a good option for men in chronic urinary retention due to BPO with concordant prostate cancer.
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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