UT Southwestern Pioneers New Minimally Invasive Treatment for Prostate Cancer

100th patient receives innovative MRI-guided ultrasound procedure to kill tumors with fewer side effects than surgery or radiation.

When McKinney real estate developer John Hill was 35, his father died of prostate cancer. The elder Mr. Hill had undergone surgery to remove his prostate a few years earlier, but the cancer had already spread.

After watching his father’s health painfully decline, Mr. Hill, now 74, vowed he would never suffer the same fate.

“I’m going to die of something,” he said, “but it’s not going to be prostate cancer.”

That’s why, when Mr. Hill received a prostate cancer diagnosis in early 2020, he knew immediately that he wanted to pursue treatment. But rather than the standard options of radiation or radical surgery, his care team at UT Southwestern offered a new option: MRI-guided transurethral ultrasound ablation, or TULSA. UT Southwestern was involved in the pivotal study (TACT) that led to the Food and Drug Administration approving the treatment.

On Oct. 15, 2020, Mr. Hill became the first clinical patient to undergo the procedure at UT Southwestern. In November, UTSW performed TULSA on its 100th patient. UTSW was one of the first medical centers in the U.S. to perform the procedure and has the highest volume among academic medical centers.

Daniel Costa, M.D., Associate Professor of Radiology at UTSW and a member of the Harold C. Simmons Comprehensive Cancer Center, said TULSA is less likely to cause the numerous problems inherent in standard prostate cancer treatments. Surgery comes with a high risk of permanent impotence or loss of urinary control; radiation causes collateral damage to healthy tissue that also has side effects and can complicate surgery if it’s necessary later.

But TULSA has fewer side effects, says Yair Lotan, M.D., Professor of Urology at UTSW and a member of the Simmons Cancer Center. In many cases, men who undergo this procedure can continue their lives much as before their diagnosis, but free of cancer.

According to Xiaosong Meng, M.D., Ph.D., Assistant Professor of Urology, a member of the Simmons Cancer Center, and a Dedman Family Scholar in Clinical Care at UTSW, this procedure is an option for most men who have low- or intermediate-risk tumors localized to the prostate. The strong collaboration between physicians in the Department of Radiology and the Department of Urology is an important element for delivering successful treatments.

In the procedure, which occurs under general anesthesia, the urologist inserts a narrow ultrasound probe into a patient’s urethra, the tube that connects the bladder to the tip of the penis. The urethra provides a natural access to the prostate without requiring any incision and allows the heat originated from this probe to reach the prostate without having to cross – and potentially damage – other organs. Under MRI guidance, the radiologist and urologist use real-time images on a computer to precisely plan and monitor heat delivery to specific areas of the prostate to kill the cancerous tissue.

Adjacent healthy tissue is normally spared, including the nerves necessary for erectile function and the sphincter that acts as a valve for urinary function. Unlike with radiation, if cancer recurs, patients still have every existing treatment option available to them, including another TULSA procedure.

After spending a short time in recovery, patients typically head home within five hours of arrival, said Kenneth Goldberg, M.D., Associate Professor of Urology at UTSW. Because there is no incision or wound, patients experience minimal pain, and symptoms are usually limited to a mild discomfort related to a urinary catheter placed after surgery. This catheter can be removed within a few days, allowing patients to resume their usual activities.

“I have treated about 35 or 40 patients myself, and they all are doing well,” Dr. Goldberg said. “We have had minimal recurrence over a year later. The vast majority have kept their erectile function, and the urination has improved. None of my patients have had significant leakage.”

Mr. Hill said that he, too, has had no side effects after about 40% of his prostate was ablated. “I had no pain, no blood, nothing. It was completely a nonevent, like nothing ever happened,” he said.

Although his doctors will continue to monitor him for cancer recurrence, Mr. Hill said he’s optimistic his cancer is gone and will choose TULSA again if it reappears.

“I’d tell anyone with prostate cancer that you’d be crazy not to consider it,” he said. “I’m grateful TULSA was an option for me.”

To obtain information about the procedure or to schedule an appointment with a UT Southwestern TULSA specialist, patients can visit this site.

Dr. Lotan holds the Jane and John Justin Distinguished Chair in Urology, in Honor of Claus G. Roehrborn, M.D.

Drs. Costa and Goldberg consult for Profound Medical Corp., which developed the device that UTSW surgeons use in performing the TULSA procedure.

About UT Southwestern Medical Center

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.