MRI-guided TULSA prostate ablation
A treatment with no incision, done inside an MRI scanner, in which a thin ultrasound rod placed through the urethra heats and destroys a planned part of the prostate, or the whole gland, while the MRI measures the temperature in real time.
Also called TULSA, TULSA-PRO, Transurethral ultrasound ablation, MRI-guided transurethral ultrasound ablation, MRI-guided prostate ablation, MR-guided ultrasound prostate treatment, Whole-gland ablation, Partial gland ablation
- Where
- Hospital MRI suite
- Anesthesia
- General anesthesia, or a spinal anesthetic with sedation
- Time in the room
- About 2 to 4 hours in the MRI suite; the heating itself often about an hour
- Hospital stay
- Same day for most
- Going home with
- Urinary catheter, through the penis or the lower belly, for about 1 to 3 weeks
- Back to normal
- About 1 to 3 weeks
- Back to work
- About 1 to 2 weeks for most jobs
Overview
TULSA stands for transurethral ultrasound ablation. Transurethral means through the urethra, the tube that carries urine through the penis and right through the middle of the prostate. Ablation means destroying tissue in place without removing it. A thin rigid rod with ultrasound elements along one side is passed through the penis until it sits inside the prostate. From there it sends ultrasound energy outward, turning slowly like a lighthouse beam, and heats the planned area of the prostate to about 55 to 57°C (131 to 135°F), hot enough to destroy cells.
The whole treatment happens inside an MRI scanner. The MRI takes temperature pictures every few seconds, and a computer turns the energy up or down and adjusts the turning speed so that the heat stops at the edge your urologist drew. Cool water runs through the rod to protect the lining of the urethra, and a separate cooling device in the rectum protects the rectal wall. Your urologist plans the treatment, watches it throughout, and can pause it at any moment.
TULSA can treat the whole prostate or only part of it, such as one half or one area. The device, TULSA-PRO by Profound Medical, was cleared by the U.S. Food and Drug Administration in 2019 to ablate prostate tissue, which is why some centers use it for prostate cancer and some also for an enlarged prostate. In the main trial for cancer, called TACT, whole-gland TULSA in men with low and intermediate-risk cancer lowered the PSA sharply in nearly all of them, most had no significant cancer on a biopsy one year later, and serious lasting side effects were uncommon. A randomized trial comparing TULSA with surgery is under way.
It is a newer treatment. Results beyond about 5 years are still being collected, and major guidelines consider ablation an option for carefully selected men, ideally with close follow-up in a study or registry. After partial treatment, the PSA does not go to zero, so regular PSA tests, MRI scans and usually a follow-up biopsy are part of the plan. Surgery or radiation remain possible later, though they may be harder after ablation.
The parts of your body involved
The prostate is a walnut-sized gland below the bladder, with the urethra running through its middle. That central channel is what makes TULSA possible: the rod sits inside the gland and heats outward. The rectum lies just behind the prostate, the urinary sphincter just below its tip, and the erection nerves along its sides, just outside the edge. TULSA aims to heat right up to the planned edge while keeping these structures cool.
- Prostate
The gland being treated, in whole or in part. Unlike a probe in the rectum, a rod inside the gland can reach the front of the prostate well, even in larger glands.
- Prostatic urethra
The part of the urethra that runs through the prostate, where the treatment rod sits. Cool water flowing through the rod protects its lining.
- Rectum
The bowel just behind the prostate. A cooling device placed in it during treatment protects its wall.
- Urinary sphincter
The ring of muscle below the prostate that keeps you dry. The treatment edge is kept a safe distance from it.
- Erection nerves
Thin nerve bundles along the sides of the prostate. In partial treatment, the nerves on the untreated side are usually unaffected.
- Bladder neck
The bottom of the bladder where it meets the prostate. The tip of the rod sits in the bladder, and the treatment starts just below it.
Why it’s done
TULSA is for men whose prostate cancer needs treatment, is limited to the prostate, and who want to avoid an operation or weeks of radiation, while accepting closer follow-up. Some centers also use it for urinary symptoms from an enlarged prostate.
- Treating cancer without an incision
There are no cuts. The rod goes in through the penis and comes out at the end.
- Whole gland or part of it
The plan can cover the whole prostate, one half, or one area, depending on where the cancer is.
- Real-time temperature control
The MRI measures the temperature throughout the treatment, so the team can see the heated area grow and stop at the planned edge.
- Reaching the front of the prostate
Because the heat starts from the center, TULSA can treat the front of the gland and larger prostates, which can be hard to reach from a probe in the rectum.
- Keeping function
In the main trial, most men kept erections firm enough for sex and very few had lasting significant leakage. Partial treatment tends to protect function more than whole-gland treatment.
- Options stay open
If cancer is found later, repeat treatment, surgery or radiation can be considered.
Other options
- Active surveillance
For low-risk and some favorable intermediate-risk cancers, regular PSA tests, MRI and biopsies, with treatment only if the cancer changes. Guidelines prefer this for most low-risk cancers.
- HIFU
Focused ultrasound from a probe in the rectum, guided by ultrasound, heating one small spot at a time. It is the most widely used ablation for prostate cancer.
- Cryoablation
Freezing needles through the skin between the scrotum and anus destroy the cancer area or the whole gland.
- Robotic radical prostatectomy
Removing the whole prostate. Long-term cancer control is well proven, with higher chances of leakage and erection problems.
- External beam radiation
Radiation from outside the body over about 1 to 9 weeks, sometimes with hormone therapy. Long-term cancer control is well proven.
- For an enlarged prostate: laser enucleation
If urinary symptoms from an enlarged prostate are the main problem, HoLEP and other well-studied procedures remove the blocking tissue.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep in the MRI suite
You are put to sleep with general anesthesia, or given a spinal anesthetic and sedation, using equipment made to work safely near the MRI. You lie on your back on the MRI table with your legs supported. Many centers also place a small catheter through the lower belly into the bladder to drain urine during and after treatment.
More detail
Staying completely still is important, because the plan is drawn on pictures taken at the start, and the treatment must match them. Anesthesia makes that possible.
After the operation
Right afterward
- Waking up
You wake in the recovery room with a catheter. Pain is usually mild, often an ache in the rectum or behind the pubic bone.
- Medicines
You may go home with an anti-inflammatory or pain medicine, a medicine to relax the prostate, a short course of antibiotics, and something for bladder spasms.
- Catheter teaching
A nurse shows you how to use the leg bag and night bag, and how to care for the catheter site if it is through the lower belly.
- Going home
Most men go home the same day. Someone must drive you.
At home
- Pain
Mild aching in the rectum, between the legs or behind the pubic bone is common for a few days. Acetaminophen and the prescribed medicine usually help.
- Catheter care
Keep the bag below your bladder, keep the tip of the penis or the belly site clean, and strap the tubing so it does not tug.
- Urine changes
After the catheter is out, burning, frequent urination and urgency are common for several weeks. Some men pass small bits of treated tissue in the urine as it heals.
- Blood in the urine
Pink urine on and off for a few weeks is common. Drink more fluids when you see it.
- Fluids and bowels
Drink plenty of fluids to keep urine pale, and avoid constipation and straining.
- Activity
Walk as you like. Avoid heavy lifting, hard exercise and bicycle riding for about 2 weeks.
- Sex
Wait until the catheter is out and you feel comfortable, often about 2 to 4 weeks. Semen volume is often reduced, and many men become dry after whole-gland treatment.
- Driving and work
Most men drive once off strong pain medicine and comfortable with the catheter. Many return to desk work within about a week.
Recovery timeline
- Day 0Treatment day
About 2 to 4 hours in the MRI suite. Most men go home the same day with a catheter.
- Weeks 1 to 3Catheter out
The catheter is removed in clinic once swelling settles. Expect some burning and frequent urination.
- Weeks 2 to 8Healing
The treated tissue is slowly absorbed. Urinary irritation eases, and you may pass small bits of tissue.
- Weeks 4 to 6Back to normal
Most men are back to normal activity, and erections are recovering.
- About 3 monthsFirst PSA
The PSA falls to a new low point. After whole-gland treatment it is usually very low; after partial treatment it stays higher because untreated tissue still makes PSA.
- About 12 monthsFollow-up MRI and biopsy
An MRI checks the treated area, and most programs advise a biopsy.
- Long termOngoing follow-up
PSA tests every few months and MRI scans continue for years. If cancer is found, repeat ablation, surgery or radiation can be considered.
What it feels like
Men often describe TULSA as easier than they feared. The hardest parts are the catheter weeks, the burning and urgency that follow, and the follow-up tests that keep the cancer in mind.
Deciding
Choosing a newer treatment can feel uncertain, and many men wonder whether they are giving up some cancer control for fewer side effects.
What helpsAsk how many TULSA treatments your center has done, what their results are, and exactly what the follow-up plan is. A second opinion from a surgeon or radiation oncologist can help you feel sure.
The MRI suite
Some men worry about the scanner, especially if they are claustrophobic. In fact, you are asleep for the part inside the scanner.
What helpsTell the team about any worries. Earplugs and the anesthesia take care of the noise and the space.
Waking up
Usually little pain, some rectal soreness, and the odd feeling of the catheter.
What helpsTell the nurse about pain or bladder cramps. Short walks help.
The catheter weeks
One to three weeks with a catheter can feel long. Spasms with urine leaking around the tube can be startling.
What helpsKeep the tube strapped to your thigh with slack, use lubricant at the tip, and take the spasm medicine if prescribed.
After the catheter comes out
Burning, needing to go often and urgently, and sometimes passing flecks of tissue. It can feel worse before it gets better.
What helpsDrink plenty of water, limit caffeine, alcohol and spicy foods, and call if you cannot pass urine.
Sex and ejaculation
Erections often return within weeks to months, but less semen or none can feel strange.
What helpsAsk what to expect for your treatment plan. Erection pills can help in the early months.
Follow-up tests
Each PSA and the follow-up biopsy can bring back worry.
What helpsAsk ahead of time what PSA pattern your team expects, so each number is easier to read.
How well it works
Success means no significant cancer is found in the treated area on follow-up MRI and biopsy, with urinary control and erections kept close to how they were before.
- PSA
The PSA drops to a new low within a few months. A steady rise from that low point may lead to an MRI or biopsy.
- MRI
An MRI about a year after treatment checks for remaining or new cancer.
- Follow-up biopsy
Most programs recommend a biopsy of the treated area, and the rest of the prostate after partial treatment, about a year later.
- Function
In the TACT trial of whole-gland treatment, most men kept erections firm enough for sex, and significant lasting leakage was rare. Loss of ejaculation was common.
- If cancer is found later
Some men need repeat treatment, and a smaller number go on to surgery or radiation. Long-term results beyond about 5 years are still being collected.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Burning, frequent urination and urgency for several weeks after the catheter comes out.
Usually mild, on and off for a few weeks.
Semen volume often drops, and many men become dry after whole-gland treatment.
Common while the catheter is in.
Erections are often weaker for weeks to months, then improve for most men.
Less common
Swelling or tissue debris can block urine after the catheter is removed, and the catheter may need to go back in for a while.
Infection of the urine or of the epididymis, the coiled tube behind the testicle, is treated with antibiotics.
Scar can narrow the urethra or bladder neck, causing a weak stream. It may need a short scope procedure.
More likely after whole-gland treatment than after partial treatment.
Mild leakage can happen early. Significant lasting leakage was rare in the main trial.
Cancer can remain or appear in the prostate, especially outside a partial treatment zone, and may need more treatment.
Rare
Heat damage could create a channel between the urethra and the rectum. The rectal cooler and safety limits are designed to prevent this.
Allergic reactions to the contrast dye are rare.
Rare. The team pads and supports your legs and arms.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills.
- No urine draining from the catheter for 1 to 2 hours with lower belly pain, or after the catheter is out, you cannot pass urine.
- Heavy bleeding or clots in the urine that do not clear with more fluids.
- Gas, stool or bubbles coming out in the urine, or urine coming from the rectum.
- Severe or worsening pain in the rectum, between the legs, or in the lower belly.
- A painful, swollen testicle.
- Swelling or pain in one calf, or sudden shortness of breath (call 911).
Questions to ask your surgeon
- Is my cancer a good fit for TULSA, and would you treat the whole gland or part of it?
- How many TULSA treatments has your center done, and what are your results?
- Will I be treated within a study or registry?
- How long will I have a catheter, and will it be through the penis or the lower belly?
- What will my PSA likely be after treatment, and what change would worry you?
- What is my follow-up plan for PSA, MRI and biopsy?
- What are my chances of leakage, erection changes and loss of ejaculation?
- Do my prostate size, calcium deposits or any implants affect whether TULSA will work?
- If cancer comes back, can I have TULSA again, surgery or radiation?
- Is this covered by my insurance?
Words you may hear
- TULSA
- Transurethral ultrasound ablation: heating prostate tissue from a rod in the urethra, guided by MRI.
- Ablation
- Destroying tissue in place with heat, cold or another energy, without removing it.
- Transurethral
- Through the urethra, the tube that carries urine through the penis and prostate.
- Prostatic urethra
- The part of the urethra that runs through the prostate.
- MRI thermometry
- Using MRI pictures to measure tissue temperature during treatment.
- Closed-loop control
- The computer adjusting the energy automatically based on the temperature it measures.
- Rectal cooling device
- A smooth device placed in the rectum that circulates cool water to protect the rectal wall.
- Whole-gland ablation
- Treating the entire prostate.
- Partial-gland ablation
- Treating only the part of the prostate with cancer, plus a margin.
- Gadolinium contrast
- A dye given by IV for MRI scans that shows blood flow. Treated tissue shows as a dark area without it.
- PSA nadir
- The lowest PSA value reached after treatment.
- Suprapubic catheter
- A catheter placed through the lower belly into the bladder.
- Fistula
- An abnormal channel between two organs, such as the urethra and the rectum.
Common questions
How is TULSA different from HIFU?
Both use ultrasound heat. HIFU aims from a probe in the rectum and heats one small spot at a time, guided by ultrasound. TULSA heats from a rod inside the urethra outward, inside an MRI that measures temperature as it goes. TULSA can reach the front of the prostate and larger glands more easily; HIFU has a longer track record.
Does it hurt?
You are asleep or numb during treatment. Afterward, most men have mild soreness and urinary irritation rather than significant pain.
Will my PSA go to zero?
Usually not. After whole-gland treatment it is often very low; after partial treatment, the untreated tissue still makes PSA. Your team watches for a steady rise from your new lowest value.
Can I have surgery or radiation later if I need it?
Yes, both remain possible, though surgery after any ablation can be more difficult because of scar tissue.
Is TULSA used for an enlarged prostate?
Some centers use it to treat urinary symptoms from an enlarged prostate, sometimes in men who also have cancer. The evidence for this use is still early compared with established BPH procedures.
Will I still ejaculate?
Many men become dry after whole-gland treatment. After partial treatment, many men still ejaculate, often with less volume.
Why does it have to be done in an MRI?
The MRI shows the prostate in detail and, uniquely, measures temperature in the tissue every few seconds. That lets the treatment stop at the planned edge.
Sources this page draws on
- American Urological Association and American Society for Radiation Oncology, Clinically Localized Prostate Cancer: AUA/ASTRO Guideline (2022)
- European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer
- The Journal of Urology, MRI-guided transurethral ultrasound ablation of prostate cancer (TACT pivotal trial; Klotz and colleagues) (2021)
- U.S. Food and Drug Administration, 510(k) clearance of the TULSA-PRO system for transurethral ultrasound ablation of prostate tissue (2019)
- Urology Care Foundation, Prostate Cancer
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.