TULSA-PRO · Prostate treatment evidence
TULSA after radiation: checking the cancer and the urinary risks
Using TULSA after radiation is a different, higher-risk decision. A specialist must first confirm where the cancer has come back. Studies report serious urinary complications. Results from men who never had radiation should not be used to call this low risk.
Medically reviewed by Michael O. Koch, MD · September 23, 2026 · Updated September 30, 2026
First find out where the cancer is
Treatment after another treatment has failed is called salvage treatment. A rising PSA after radiation is a reason to be checked. On its own, it does not show where the cancer is. The salvage TULSA studies here only included men whose returning cancer was confirmed by biopsy. They used MRI and a PSMA PET scan to check that the cancer seemed to be only in the prostate. So their results apply to that chosen group, not to every man with a rising PSA. Phase I selection. Phase II selection.
The talk should also cover your past radiation, how well you urinate now, past procedures and your overall health. Options for returning cancer depend on your situation. A specialist should explain why another local treatment is being offered and which other choices still make sense. NCI information on treating cancer that comes back.
Read the cancer results next to the harms
| Study group | Cancer result | Safety and meaning |
|---|---|---|
| Phase I: 11 menChecked at one year | 10 of 11 had no cancer in the treated area. Two had cancer come back outside the treated area. | One grade 3 and three grade 2 side effects, related to trouble emptying the bladder and infection. A clear treated area does not rule out cancer elsewhere. |
| Phase II: 39 menMedian follow-up 40 months | At 12 months, 89% had no cancer found in the treated area. | 56% had a side effect of some kind. 28% had severe urinary or genital problems, meaning grade 3 or higher or a hospital stay. This is a major part of the decision. |
Talk openly about the serious complications
In the phase II study, three men developed a fistula, an abnormal channel between the urethra inside the prostate and the pubic bone. Two men needed their bladder removed (cystectomy). Only 53% stayed fully dry, with no leakage. Discuss these results directly. Your specialist should explain how you and your planned treatment compare with the men in the study. These numbers are not your personal risk. But they cannot be brushed aside using results from men who never had radiation. Full study record.
A salvage visit needs two maps
1. The cancer map
- What has the biopsy confirmed, and where is it?
- What do MRI and other scans show inside and outside the prostate?
- What is the planned target? What is still uncertain outside it?
- Which finding would change the advice from local treatment to another approach?
2. The past-treatment and function map
- What radiation and prostate procedures have I already had?
- Do I already have urinary symptoms, leakage, narrowing or other problems that need checking?
- How do those findings change the plan, the expected recovery and the risk talk?
- Which team would treat a serious urinary complication, or more cancer?
Why long-term estimates are not guarantees
A small study with no comparison group can describe what happened to its own patients. It cannot prove TULSA is better than other salvage treatments. The length of follow-up also varies from man to man. A statistical estimate for a later year does not mean every man was followed that long.
That is why this page keeps the one-year treated-area results apart from the follow-up length and the side-effect results. Ask a specialist for the result that matters most to your decision. That may be cancer outside the target, spread, more treatment, urinary function or something else. Also ask how many men were still being followed at that time.
Before you go ahead, your care plan should name the doctor in charge of follow-up. It should also name the service that handles urgent complications. A plan that is technically possible is only one part of the decision. The other part is whether more local treatment offers a fair balance of benefit and harm for you.
Take these questions to your care team
Modern Prostate Institute does not offer patient intake or TULSA provider matching. Talk with your own doctor or a hospital urology service about your records and options. Do not send medical records through a public contact form.
Read our care-navigation guidance →
Medically reviewed by
Michael O. Koch, MD
John P. Donohue Professor of Urology at Indiana University School of Medicine. He chaired the university’s urology department from 1998 to 2024. Dr. Koch reviewed these TULSA pages on September 23, 2026 and sent the corrections included here. He is an author of the TACT five-year and CAPTAIN reports cited on these pages.
About Dr. Koch and his review →