Transurethral Ultrasound Ablation (TULSA-PRO) for Prostate Cancer

Broader than Focal, Less than Total

Transurethral ultrasound ablation (TULSA-PRO) can more easily cover a wider area than laser focal therapy (LFT) / focal laser ablation (FLA).  For patients who have a relatively larger cancer, or somewhat diffuse cancer within the prostate, TULSA-PRO can cover almost the entire prostate gland in many patients.   

This is a minimally invasive procedure performed at the Prostate Laser Center (a HALO Diagnostics Company) that combines real-time 3T MRI with robotically-driven directional thermal ultrasound energy to perform subtotal or targeted prostate gland ablation. There are no incisions or radiation.

TULSA-PRO is a customizable, predictable, and incision-free procedure that allows the doctor to tailor the ablation to each patient. Once the boundary lines and volume to be ablated are mapped, the ablation process is computer controlled with real time temperature feedback. The procedure is performed with high intensity directional ultrasound to ablate tissue in a controlled manner.

Individualized Elements

After the placement of the device and initial MRI scanning, the physician enters a treatment plan. The TULSA-PRO system then individually controls ten separate elements, allowing for broad tissue destruction while fine tuning each treatment area. This is all performed under the watchful eye of the physician who can make adjustments as appropriate. 

An endorectal cooling system protects the rectum. (The patient is asleep before that goes in.)

Tulsa Prostate Diagram

Advantages of TULSA-PRO

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Decreased Risk of Side Effects

TULSA-PRO has a decreased risk of erectile and urinary side effects compared to whole gland therapy.[1]

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Same-Day Outpatient Procedure

TULSA-PRO is performed in a single session that takes a few hours.

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Keep Your Options Open

If you are in need of future prostate care, you may either have a repeat TULSA procedure, or choose any other type of prostate therapy to address your prostate needs.[2]

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Advanced Image Guidance

Directional thermal ultrasound and MR imaging with active heat monitoring.

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Customizable Treatment Plans

TULSA-PRO is customizable and personalized based on your situation and goals.

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Shared Decision Making

Before your TULSA procedure, you will decide with your physician on a treatment plan. 

How Dr. Karamanian Performs the TULSA Procedure

The TULSA procedure (TULSA-PRO) ablates prostate tissue from the inside out. A device enters the urethra which delivers thermal ultrasound energy outwards from the urethra to the prostate while under real-time MRI guidance.

This approach avoids the need for surgical incisions to reach the prostate. A cooling mechanism helps protect the urethra from the ultrasound energy. The thermal ultrasound energy is delivered in a sweeping motion (visualize a clock hand sweeping), which enables the physician to ablate a wider area.

Tulsa Pro Procedure Video
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Tulsa Pro Imaging

TULSA-PRO produces real-time temperature maps, enabling the physician to see the increasing temperature of the prostate tissue and surrounding structures every 5-7 seconds during treatment. This visibility allows the physician to actively monitor tissue heating.

Frequently Asked Questions

Our physicians can customize the procedure to ablate a specific area of the prostate or almost the entire prostate, depending on your needs and functional outcome goals.

As with many procedures, there are side effects associated with the TULSA procedure. The most common side effects include pain/discomfort in the procedure area, blood in urine, urinary tract infection, urinary incontinence, and erectile dysfunction. According to the TACT: TULSA® Ablation Clinical Trial conducted by Profound Medical (the makers of TULSA), the study found patients had a 2.6% urinary incontinence risk and 25% erectile dysfunction risk.

Whether a patient qualifies for the TULSA procedure will be determined by the treating physician on a case by case basis. In general, patients should have low to intermediate risk disease which is confined to the prostate.  Generally, the patient should have a PSA of less than 20.  If a patient has significant calcifications within the prostate (as determined by a CT scan), then they are not a candidate for TULSA, because the calcifications will block sound waves. Patients should be relatively healthy and able to undergo general anesthesia. Contact us if you would like more information.

What to Expect

TULSA for Prostate Cancer

Wondering what to expect before, during, and after your TULSA for prostate cancer procedure? Take a look here.


[1] Hatiboglu G, Popeneciu V, Bonekamp D, Burtnyk M, Staruch R, Distler F, Radtke JP, Motsch J, Schlemmer HP, Pahernik S and Nyarangi-Dix J (2021) Single-Center Evaluation of Treatment Success Using Two Different Protocols for MRI–Guided Transurethral Ultrasound Ablation of Localized Prostate Cancer. Front. Oncol. 11:782546. doi: 10.3389/fonc.2021.782546

[2] Nair, S.M., Stern, N., Dewar, M. et al. (2020). Salvage open radical prostatectomy for recurrent prostate cancer following MRI-guided transurethral ultrasound ablation (TULSA) of the prostate: Feasibility and efficacy. Scandinavian Journal of Urology, 54(3), 215-219. doi: 10.1080/21681805.2020.1752795

Dr Ara Karamanian 3

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