44 - Oncologic and Functional Outcomes Following MRI-Guided Transurethral Ultrasound Ablation for Localized Prostate Cancer: A Systematic Review and Meta-Analysis

Purpose: This study aimed to conduct a systematic review and meta-analysis to evaluate oncologic and functional outcomes following MRI-guided transurethral ultrasound ablation (TULSA) for localized prostate cancer.

Materials and Methods: A systematic literature search was performed in PubMed, Embase, Web of Science, and Cochrane (CENTRAL) from inception to September 2025 to identify relevant studies studies. Case reports, reviews, non-human studies, duplicates, and studies without extractable comparative data were excluded. Oncologic outcomes included biochemical recurrence-free survival (BCRFS, defined by Phoenix criteria), clinically significant prostate cancer (csPCa) on follow-up biopsy, recurrence on magnetic resonance imaging (MRI), prostate-specific antigen (PSA) decline, and progression to salvage therapy. Functional outcomes included urinary continence (Expanded Prostate Cancer Index Composite, EPIC), lower urinary tract symptoms (International Prostate Symptom Score, IPSS), and sexual potency (International Index of Erectile Function, IIEF/SHIM). Pooled analyses were performed using random-effects models to calculate proportions or mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was quantified with the I² statistic and analyses were conducted in accordance with PRISMA guidelines {1}.

Results: Fifteen studies comprising 595 patients were included. The pooled biochemical recurrence rate was 9% (95% CI: 2–20%; p = 0.0013), corresponding to a BCRFS of 91%. csPCa was identified on follow-up biopsy in 29% (95% CI: 19–40%; p = 0.036), while MRI-based recurrence occurred in 15% (95% CI: 7–25%; p < 0.001). PSA declined significantly following treatment, with a pooled mean reduction of –4.53 ng/mL (95% CI: –5.48 to –3.58; p < 0.001). Progression to salvage therapy occurred in 14% of patients (95% CI: 6–26%; p < 0.001). Functional outcomes were favorable: urinary continence was maintained in 96% (95% CI: 86–100%; p < 0.001), IPSS improved with a mean reduction of –4.33 points (95% CI: –8.51 to –0.15; p < 0.05), and IIEF/SHIM scores showed no significant change (MD –0.07; 95% CI: –0.23 to 0.09; p = 0.98), indicating preserved potency.

Conclusion: TULSA provides promising oncologic control with high BCRFS and significant PSA reduction, while preserving continence and potency and improving urinary symptoms. Residual disease and heterogeneity across studies highlight the need for standardized follow-up and long-term trials to validate its role against established treatments.