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TULSA-PRO

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User
Posted 24 Oct 2023 at 15:20

I thought it might be useful to give a report on my recent Tulsa-Pro treatment, since there appears to be little information about it on this forum.

I was diagnosed in June 2020 with Gleason score 4+3=7 adenocarcinoma from 3 positive cores out of 12 using a perennial biopsy. PSA was 11.5, having risen from 3.52 in 2017. Bone scan and multiparametric MRI showed no evidence of metastasis. MRI estimated a single lesion with approximate diameter 23mm in the anterior transitional zone. Clinical stage T2cN0M0 becasue tumour was located slightly to the left of the midline.

I had the TULSA procedure in September 2020 to ablate about 45% of my prostate. It was roughly a 3.5 hour general anaesthetic operation, followed by a two night hospital stay. I needed self-catheterisation (clean intermittent catheterisation) for about two months post-op. I had hormone therapy for six months using a combination of Delgalerix (abdominal injection) and bicalutamide (tablets).

Follow-up MRI checks over the subsequent three years were all non-suspicious. PSA values were 0.538 immediately post procedure, then a nadir of 0.02 in December 2020. Subsequent PSA: 0.529 May 2021, 0.576 January 2022, 0.678 April 2023, 0.663 October 2023.

Urine flow was improved  by the procedure, and my sexual function was not degraded, apart from some reduction in semen volume. At this stage I am very satisfied with the treatment.

It was carried out at Hokuyu Hospital in Sapporo, since I spend a lot of time in Japan, and becasue there are no centres in the UK. The care there was excellent, and although BUPA do not cover TULSA, the cost was not too high at about GBP8,000 equivalent. Highly recommended!

 

Edited by member 24 Oct 2023 at 15:58  | Reason: Not specified

User
Posted 24 Oct 2023 at 15:20

I thought it might be useful to give a report on my recent Tulsa-Pro treatment, since there appears to be little information about it on this forum.

I was diagnosed in June 2020 with Gleason score 4+3=7 adenocarcinoma from 3 positive cores out of 12 using a perennial biopsy. PSA was 11.5, having risen from 3.52 in 2017. Bone scan and multiparametric MRI showed no evidence of metastasis. MRI estimated a single lesion with approximate diameter 23mm in the anterior transitional zone. Clinical stage T2cN0M0 becasue tumour was located slightly to the left of the midline.

I had the TULSA procedure in September 2020 to ablate about 45% of my prostate. It was roughly a 3.5 hour general anaesthetic operation, followed by a two night hospital stay. I needed self-catheterisation (clean intermittent catheterisation) for about two months post-op. I had hormone therapy for six months using a combination of Delgalerix (abdominal injection) and bicalutamide (tablets).

Follow-up MRI checks over the subsequent three years were all non-suspicious. PSA values were 0.538 immediately post procedure, then a nadir of 0.02 in December 2020. Subsequent PSA: 0.529 May 2021, 0.576 January 2022, 0.678 April 2023, 0.663 October 2023.

Urine flow was improved  by the procedure, and my sexual function was not degraded, apart from some reduction in semen volume. At this stage I am very satisfied with the treatment.

It was carried out at Hokuyu Hospital in Sapporo, since I spend a lot of time in Japan, and becasue there are no centres in the UK. The care there was excellent, and although BUPA do not cover TULSA, the cost was not too high at about GBP8,000 equivalent. Highly recommended!

 

Edited by member 24 Oct 2023 at 15:58  | Reason: Not specified

User
Posted 25 Oct 2023 at 14:44

Interesting.

I've consulted Professor Google about Tulsa-pro.  It seems to be a version of HIFU, in that it involves partial ablation of the prostate by localised heating induced by ultrasound.   Except that  the ultrasound delivery is transurethral rather than transrectal. That is, the device emitting the ultrasound delivery is inserted into the urethra rather than the rectum.  The urethra itself is protected by water cooling, as is the rectum, in order to provide 'thermal protection of important anatomy' .  

The relevant website (profoundmedical.com) claims it has been used to treat large prostates up to 250cc.  (Crikey! I thought mine was big at 50cc!). And that it can treat anterior prostate tissue.  Which implies that (in such cases) it would be able to treat lesions for which HIFU is regarded as unsuitable.

Nothing on that website mentions a need for 2 nights in hospital, or 6 months of hormone treatment, or 2 months  with catheters.  Any one of those 3 requirements (if routinely needed) might rule it out as a potential competitor against HIFU in the UK, unless it could be shown to be dramatically more effective against long term cancer recurrence.  

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User
Posted 24 Oct 2023 at 20:18
Hi and thank you for posting. I think you may be the first person to have reported having had this treatment on this forum, the reason being it is not yet available in the UK and this is a UK forum, although we have a few members from a number of countries. I have mentioned and linked to Tulsa-Pro on a few occasions with the thought somebody might go to Germany or elsewhere nearer to UK where the procedure is undertaken. So please continue to update your progress which hopefully will be very satisfactory.
Barry
User
Posted 25 Oct 2023 at 14:44

Interesting.

I've consulted Professor Google about Tulsa-pro.  It seems to be a version of HIFU, in that it involves partial ablation of the prostate by localised heating induced by ultrasound.   Except that  the ultrasound delivery is transurethral rather than transrectal. That is, the device emitting the ultrasound delivery is inserted into the urethra rather than the rectum.  The urethra itself is protected by water cooling, as is the rectum, in order to provide 'thermal protection of important anatomy' .  

The relevant website (profoundmedical.com) claims it has been used to treat large prostates up to 250cc.  (Crikey! I thought mine was big at 50cc!). And that it can treat anterior prostate tissue.  Which implies that (in such cases) it would be able to treat lesions for which HIFU is regarded as unsuitable.

Nothing on that website mentions a need for 2 nights in hospital, or 6 months of hormone treatment, or 2 months  with catheters.  Any one of those 3 requirements (if routinely needed) might rule it out as a potential competitor against HIFU in the UK, unless it could be shown to be dramatically more effective against long term cancer recurrence.  

User
Posted 25 Oct 2023 at 21:43

I think you will find this interesting. It mentions a night in hospital before leaving next day. Heidelberg University Hospital in Germany seem to have the most participants in a trial and this is what they show :- https://www.profoundmedical.com/wp-content/uploads/2015/05/Phase1ResultsPresentationFUS_London2015_pdf.pdf

 

Edited by member 25 Oct 2023 at 21:44  | Reason: to highlight link

Barry
User
Posted 26 Oct 2023 at 22:31

Thanks for that reference which tells us more about Tulsa. 

User
Posted 03 Jan 2024 at 15:13

Hi,

I'm not going to get into the have this treatment have that treatment scenario, but if anyone wishes more information on the TULSA treatment I may be able to help.

There are currently 7 centers in Europe that are using the TULSA system with more to come on line through 2024. Sadly, nothing is scheduled for the UK yet and there is no NHS England recognition of the treatment yet although there is vague NICE recommendations for MRgFUS/HIFU it's still not great.

Some centers will perform the treatment as a day case others like you to stay for 1 to 2 days, it is a general anaesthesia procedure. This is in part is dependent on what center is performing the treatment, private imaging center or hospital environment and the types of financial coverage that is available.

Sites generally don't follow up with drug therapy after treatment but this is more patient specific and the stage of the disease being treated and your urologists concerns.

A catheter of some kind is usually required afterwards for 1-2 weeks to help with bladder voiding, but again this is dependent on your urologist and your personal requirements.

User
Posted 01 Feb 2024 at 23:40

Thanks for your interesting update on Tulsa-pro.
Have you spoke to anyone else who had this treatment?  How did they get on?

User
Posted 16 Feb 2024 at 22:39

Hi,

I’m actually a clinical specialist for Profound medical who are the manufacturer of the system. It’s difficult for me to not be biased on the TULSA-PRO system. I’ve been working in high intensity focused ultrasound for 23years. Directly in Prostate cancer for the last 6months. This is one of those products in medicine that really does do what it says on the tin. I’m sad to say it’s not currently available in the UK, but I hope we can change that within the next 12 months.

User
Posted 17 Feb 2024 at 08:34

Originally Posted by: Online Community Member
I’m actually a clinical specialist for Profound medical who are the manufacturer of the system. It’s difficult for me to not be biased on the TULSA-PRO system. I’ve been working in high intensity focused ultrasound for 23years. Directly in Prostate cancer for the last 6months.

I thought a Tulsa-pro was a toothbrush? 

Joking apart Paul, that's a very impressive CV. Welcome to the forum. Your expertise and specialist knowledge  will be much appreciated.

 

 

Edited by member 17 Feb 2024 at 08:50  | Reason: Typo.

User
Posted 03 Jun 2024 at 19:10

Hi Paul,

I went to an appointment here in the UK with my brother who has prostate cancer and I mentioned Tulsa Pro.  The consultant said he was very familiar with it, said it was trialed in the UK a few years ago and the general thinking was that it was not ideal for full prostate ablation.  The reason provided was that being from the inside out it could miss cancer cells at the periphery of the organ.  Having read the material at the website, I'm not sure about this.  The consultant carries out the following procedures plus others: removal, cryotherapy and HIFU.  I'll try calling the Tulsa Pro center in the Netherlands or the Profound Medical to get their opinion on this but wanted to get your feedback.  Thanks, Harry. 

User
Posted 04 Jun 2024 at 08:01

Hi Harry,

TULSA is great for focal PCa ablations with or without BHP. It can perform partial or whole gland ablations. 
Since the Initial TACT trial which had impressive results, a center in the UK played a part, the system has gone on to be further improved in a number of directions including the depth at which it can treat. 
It has a maximum reach of around 30mm from the urethra giving a 60mm diameter of treatment. However, an added feature called boost can increase this distance by a couple of mm and or give possibly improved ablative coverage to treatment region. It’s dependent on a few things including the different tissue types within the gland. The systems advantage is that it treats from the inside to out and can reach the glands capsule.

Outside the US and Canada, there are currently treatment sites in Europe, Germany, France, Netherlands and Finland with expansion planned for this year.

Good luck and best wishes

 

User
Posted 04 Jun 2024 at 09:07

Many thanks Paul !  I appreciate your response.

 

 
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