A new randomised controlled trial found that men with localised, intermediate‑risk prostate cancer recovered faster and experienced less short‑term impact on their daily lives when treated with magnetic resonance imaging (MRI)‑guided, transurethral ultrasound ablation (TULSA) compared with robotic prostate surgery. The results of the CAPTAIN trial were presented at the Society of Interventional Radiology (SIR) annual scientific meeting (11–15 April, Toronto, Canada).
Presenting author and principal investigator, David A Woodrum (Mayo Clinic, Rochester, USA) stated that the study followed 212 men treated at 23 medical centres between 2022 and 2025. Participants with localised, intermediate-risk prostate cancer were randomly assigned to receive either TULSA or robotic prostatectomy—the current standard surgical approach.
TULSA vs. robotic prostatectomy patients with grade group 2/3 histology were 76%/24% vs. 77%/23% (p=0.88), respectively. The speaker reported that most TULSA plans were designed for subtotal ablation with strategic sparing; median (IQR) fraction of the prostate heated to ablative temperatures measured by intraprocedural MRI thermometry was 78% (71–85%). For robotic prostatectomy, 77% had pelvic lymph node dissection.
Woodrum reported that men treated with TULSA had less blood loss during the procedure (0 [0–0] vs. 100 [100–200]ml), typically went home the same day (0.29 [0.27–0.32] vs. 1.24 [1.12–1.36] days), and reported less pain and faster return to normal activities one month after treatment. Surgical patients had higher rates of blood loss, were more likely to stay overnight in the hospital and reported slower recovery.
“For many patients, how quickly they can get back to work, family life and everyday routines really matter,” said Woodrum. “These early results suggest that TULSA may allow patients to recover more quickly and maintain a better quality of life following treatment, while still effectively treating the cancer.”
Although surgical removal of the prostate, which is the typical standard of care at present, is effective in terms of controlling the cancer, Woodrum highlighted that it may leave men with significant long-term effects such as erectile dysfunction and loss of bladder control. TUSLA, however, uses real-time MRI to guide the delivery of high-energy ultrasound through the urethra and intro the prostate to heat and kill the prostate cancer tissue without damaging the surrounding organs. The speaker continued, underscoring the benefit this treatment has for the preservation of urinary and sexual function.
“While longer‑term cancer control and functional outcomes remain critical, early recovery is an important part of the treatment decision for patients,” said Woodrum. “CAPTAIN is providing high‑quality randomised data to help patients and physicians have more informed conversations about treatment options.”
He added that researchers plan to follow participants over 10 years to compare longer‑term outcomes, including urinary control, sexual function and whether additional cancer treatment is needed.
