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Breakthroughs in Men’s Health: A New Prostate Cancer Treatment and More
Ultrasound treatments with fewer side effects, plus help for erectile dysfunction and prostate enlargement
The TULSA-Pro procedure treats prostate cancer with minimal side effects.
Illustration by Glenn Harvey
Tommy Saul, 57, takes prostate cancer seriously. His father died after a 12-year fight with the disease, the second-leading cause of cancer death in men. So when Saul’s annual prostate specific antigen test (a measure of prostate health) showed that his PSA levels had doubled, and a biopsy in 2022 confirmed that he had prostate cancer himself, his doctors urged radiation or immediate surgery to remove his prostate gland. Still, despite his family history, Saul hesitated. “I didn’t like the side effects — urinary incontinence and erectile dysfunction,” Saul says. “But I wanted to live a long time for my wife and our three sons. That’s when we did a lot of research.”
Saul and his wife, Autumn, decided that he was a good candidate for TULSA-Pro, an outpatient procedure cleared by the FDA in 2019 that destroys cancerous tissue from inside the prostate gland with ultrasound heat. Doctors use magnetic resonance imaging to guide the robotic procedure while a cooling catheter inserted in the rectum reduces heat exposure of nearby tissue. Recovery is generally faster than with surgery or radiation. It’s intended mostly for men with low- and intermediate-risk prostate cancer that hasn’t spread.
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Tommy Saul with his wife, Autumn
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“The goal is to minimize side effects,” says Yair Lotan, M.D., chief of urologic oncology at the University of Texas Southwestern Medical Center, in Dallas. “We can’t guarantee a risk-free experience. But with magnetic resonance imaging to guide the procedure, we can be very precise.”
In a recent study of 115 midlife and older men with low- to intermediate-risk prostate cancer who had their prostate gland completely treated via TULSA-Pro, 96 percent of participants saw their PSA levels fall by 75 percent or more within a year, 25 percent had new problems with erectile dysfunction (ED), and 11 percent reported some urinary leakage or incontinence.
By three years after their procedures, 13 percent needed additional prostate cancer treatment, but none had severe erectile problems, and 99 percent didn’t need pads for managing incontinence.
In contrast, 25 percent to 33 percent of men who undergo standard surgery or radiation treatment see their cancer return, according to the Prostate Cancer Foundation. Up to 23 percent may have lingering incontinence after surgery, and up to 50 percent may have ongoing ED a year or more after surgery or radiation. These side effects can dramatically affect a man’s quality of life.
Lotan says ultrasound and other “focal” cancer therapies that treat part of the prostate are active areas of research offering new hope to men with prostate cancer. “Twenty years ago if you had prostate cancer, it was surgery or radiation,” he says. “Now focal therapy is an evolving area.”
Saul says he’s had no incontinence or erectile dysfunction since his TULSA procedure at the Ronald Reagan UCLA Medical Center, in Los Angeles, in August 2022. “I travel a lot for my job, on jets without restrooms,” he says. “And my wife and I have a passionate relationship. We didn’t want to lose that.”
Follow-up tests show his PSA levels have dropped from 12 to 3, an encouraging sign, and MRI scans of his prostate haven’t found any trouble spots or signs of cancer.
“At a different stage of life or a different stage of cancer, surgery or radiation might have been the best option,” Saul says. “But this was perfect for me.”
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More Men’s Health Breakthroughs
Over-the-counter help for erectile dysfunction
A nonprescription gel that helps men get an erection within 10 minutes received FDA clearance in June. Eroxon, already sold in Europe, stimulates nerves involved with erections by cooling then warming the penis, which makes blood vessels dilate, according to maker Futura Medical. It’s effective for 65 percent of people who try it, the company says.
New treatment for relieving symptoms of prostate enlargement
A new catheter system approved by the FDA this past June treats troublesome urination problems caused by benign prostatic hyperplasia (BPH) — an enlarged prostate. The Optilume BPH Catheter System is a drug-coated balloon that expands in the prostate gland opening, enlarging it to allow for the flow of urine. At the same time, the device releases the medication paclitaxel to help prostate tissue heal. Men with BPH often have to pee repeatedly and urgently, and may have difficulty starting a stream of urine or experience a weak flow. Those who underwent the new catheter procedure not only increased their urinary flow rate by more than 70 percent, but they were still reporting urinary improvement four years later, according to a 2023 study of 80 subjects.
On the Horizon
Lab-grown hair follicles for baldness
Japanese researchers have grown hair follicles in a lab by reprogramming mouse cells, and most sprouted hairs that grew to about a 10th of an inch long. In the future, the follicles could be used to test hair-loss treatments, they say.
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