Darrin Hawkes

The future of precision medicine hasn’t just reached New Zealand; it has arrived in Gisborne.

On October 30, I attended a seminar at Mātai Medical Research Institute where visiting Stanford University experts discussed advances in MRI-guided treatments.

The following day I returned for the opening of the Hugh Green Prostate Centre, the first facility in Australasia to offer MRI-guided prostate cancer transurethral ultrasound ablation, TULSA-PRO.

More importantly, the first two patients had already been successfully treated earlier that week.

As an engineer, what I saw fascinated me. As someone interested in improving New Zealand’s health system, it also gave me considerable hope.

TULSA-PRO, Transurethral Ultrasound Ablation, sounds complicated, but the concept is surprisingly straightforward.

Most of us think of MRI as a machine doctors use to find something wrong.

With TULSA-PRO, MRI becomes part of the treatment.

While the patient is inside the scanner, a small ultrasound device positioned through the urethra delivers precisely controlled energy into selected areas of the prostate, generating heat to destroy targeted tissue, typically cancer cells.

MRI lets the clinical team see what they are treating and monitor temperature in real time, controlling where heat is delivered while protecting important surrounding tissue.

In simple terms: find the target, treat the target, minimise damage around it. There is no surgical incision or ionising radiation from the treatment.

Conducted under general anaesthetic, it typically takes three to four hours. Patients can generally go home the same day and return to normal activities within days. That is a remarkable change from what many imagine when they hear “cancer treatment”.

It is particularly important for prostate cancer. Around 4500 New Zealand men are diagnosed each year, about 12 every day. Existing treatments, including surgery and radiotherapy, can be highly effective and remain essential. But depending on the patient and treatment, there can be consequences for urinary continence and sexual function.

The Hugh Green Prostate Centre now offers another tool for appropriately selected patients, potentially treating cancer while reducing damage to surrounding tissue. That qualification matters.

TULSA-PRO is not a miracle cure or suitable for every prostate cancer. Some patients will still require surgery, radiotherapy or other treatments.

The type, position and extent of cancer all matter. What makes TULSA-PRO exciting is not that it is a “cure-all”, but that it gives clinicians another increasingly precise tool to match treatment to the individual patient.

Early results are encouraging. At the seminar I heard about Stanford’s experience with 148 intermediate-risk prostate cancer patients.

Using a refined treatment protocol, 96 percent were recurrence-free within treated areas at 12 months. Treatment can also be repeated and used before or after other treatments.

What I found even more interesting was that researchers are not only measuring whether they successfully treat the cancer.

They are examining what happens afterwards to urinary function, sexual function and quality of life.

It reflects an important change in medicine: success isn’t just about surviving disease. It is also about how well you can live after treatment.

The technology reaches beyond prostate cancer. MRI-guided focused ultrasound is being developed and used internationally for conditions including uterine fibroids, painful bone metastases and neurological disorders.

Stanford researchers are exploring how precisely targeted ultrasound can treat abnormal tissue without conventional surgery.

That makes what Mātai has established potentially even more exciting. Today’s focus is prostate cancer, but the specialised imaging capability, clinical expertise and infrastructure create a potential platform for other MRI-guided treatments.

However, technology alone, isn’t enough. One of my more surprising learnings was the importance of anaesthesia.

TULSA-PRO requires general anaesthesia within an MRI environment. Establishing Gisborne’s first MRI-compatible general anaesthesia service was essential. A multimillion-dollar machine cannot treat anybody without skilled people and supporting systems.

The same applies across regional healthcare. Advanced treatment achieves little if patients cannot reach it, referrals are unavailable, diagnostics are overloaded, or shortages of anaesthetists and other professionals limit its use.

Roads, workforce, diagnostic facilities, referral pathways and clinical services are all healthcare infrastructure. That particularly matters here, where patients may travel considerable distances for specialist care.

That is why this centre is significant beyond its technology. We are accustomed to regional patients travelling to Auckland or other major centres for specialised medicine. This time, Gisborne has become the destination.

The Hugh Green Prostate Centre is the first Australasian service of its kind, made possible through years of research, determination, international collaboration, a dedicated local clinical team and significant philanthropic support, including $1.57 million from the Hugh Green Foundation.

There is still work ahead. Capacity must grow, sustainable pathways for wider public access must develop, clinical results require continued monitoring, and the specialist workforce and infrastructure must grow alongside the technology.

Mātai is not only delivering the service but actively participating in health succession development.

We should be cautious describing new medical technology as revolutionary, but equally careful not to overlook genuine advances.

I went to Mātai expecting to learn about an interesting prostate cancer treatment and came away thinking about something bigger.

For suitable patients, treatment can take hours, with patients generally home the same day and returning to normal life within days. But it relies on skilled people, supporting health services and infrastructure that lets patients access it.

Mātai has overcome those obstacles and is now treating patients. That is potential unlocked. There is much more that could be unlocked.

Future aspirations include exploring MRI-guided treatments for neurological conditions such as essential tremor and Parkinson’s disease, potentially helping people retain something most of us take for granted: control of our own movement and independence.

There is still research, investment and hard work ahead.

This week I saw what unlocking that potential can mean for prostate cancer. Imagine what could be unlocked next.