Baseline Prostatic Specific Antigen Does Not Predict The Outcome Of High Energy Transurethral Microwave Thermotherapy

Korean clinical practice guideline for benign prostatic hyperplasia

In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years.

Revival of thermotherapy for benign prostatic hyperplasia

PURPOSE OF REVIEW

Transurethral resection of the prostate (TURP) has long been held as the gold standard for treatment of benign prostatic hyperplasia (BPH); however, there has been significant innovation in other less invasive alternative treatments for BPH in recent years. BPH treatment guidelines now recommend minimally invasive therapy be considered as a treatment option alongside TURP and medical management. Our purpose is to review the current evidence supporting the safety, effectiveness, and durability of transurethral microwave thermotherapy (TUMT) as a minimal invasive technique.

RECENT FINDINGS

Recent clinical studies of TUMT have provided significant evidence regarding safety, efficacy, and durability. TUMT has now become a minimally invasive office-based alternative to both standard TURP and medical therapy in the treatment of bladder outlet obstruction and lower urinatry tract symptoms due to BPH.

SUMMARY

TUMT treatment has improved with the advent of later generation devices. This well tolerated, effective, and durable therapy for the treatment of BPH has definitively found its place as one of the alternatives to TURP. Anestheisa-free outpatient capability, lack of sexual side-effects, and avoidance of actual surgery are attractive to patient and clinician alike. TUMT deserves reconsideration in clinical practices as a suitable treatment alternative to TURP and medical therapy.

Transurethral microwave thermotherapy for the treatment of BPH: still a challenger?

Minimally invasive therapies for treatment of benign prostatic hyperplasia (BPH) compete with the gold standard transurethral resection of the prostate (TURP). Comparisons of efficacy and safety have broadened the knowledge of different treatment modalities. Concerns of quality of life such as unaltered sexual function as well as cost considerations drive the market to develop techniques of lower level invasiveness. Among the competitors the office based transurethral microwave thermotherapy (TUMT) provides the broadest scale of scientific data. Numerous manufacturers sell various modifications of this technology. According to different clinical studies TUMT proved to be an effective, safe, and durable therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. However, TURP still holds the steadier long-term results and is more effective to reduce obstruction as well as other LUTS.

TRANSURETHRAL MICROWAVE THERMOTHERAPY FOR BENIGN PROSTATE HYPERPLASIA: SEPARATING TRUTH FROM MARKETING HYPE

PURPOSE

Transurethral microwave thermotherapy (TUMT) is being used with increasing frequency by urologists as a minimally invasive therapy for benign prostatic hyperplasia (BPH). There are various modifications to this technology, with each manufacturer touting safety and efficacy. We review the rationale of TUMT, as well as the historical safety and efficacy of this approach.

MATERIALS AND METHODS

We reviewed the medical literature, including peer reviewed articles and abstracts. In addition, we analyzed promotional material distributed by various manufacturers with respect to scientific accuracy.

RESULTS

TUMT results in consistent improvement in symptoms and peak urinary flow rate. Symptom improvement ranges between 9 and 11 points, compared to a 6-point improvement in sham treated patients, and peak urinary flow rate increases 3 to 5 ml per second. The degree of coagulation necrosis is different among the various TUMT devices. Although coagulation necrosis is believed to be an important proxy for clinical success, there are few data that correlate this factor with the magnitude of either symptomatic or uroflow improvement.

CONCLUSIONS

TUMT is a safe and effective therapy for the treatment of lower urinary tract symptoms secondary to BPH. In addition, there are distinct advantages to each of the devices. However, intense marketing and hyperbole have dominated this segment of the BPH market. Ultimately, the most effective TUMT device can only be determined by direct comparison studies.

Thermotherapy and thermoablation for benign prostatic hyperplasia

PURPOSE OF REVIEW

From all the available thermoablative methods for the treatment of symptomatic benign prostatic hyperplasia, transurethral microwave thermotherapy is considered as standard in minimally invasive management. The literature is enriched by several new studies on transurethral microwave thermotherapy, and thus this review presents up-to-date information about thermotherapy.

RECENT FINDINGS

New studies have provided significant information regarding differences in outcome for devices with different protocols and selection criteria, confirming the superiority of high-energy programmes. Furthermore, monitoring of the intraprostatic temperature promises better clinical results by means of individualization of the treatment. Long-term results have been available and allow the evaluation of the fundamental issue of treatment durability. Improvement after high-energy transurethral microwave thermotherapy remains durable for more than 2.5 years. Randomized studies comparing this treatment with other established therapies for benign prostatic hyperplasia, including medical treatment and transurethral resection of the prostate, have also contributed to an evaluation of the morbidity, and costs of treatment. Clinical outcomes with transurethral microwave thermotherapy are in the range of those obtained with transurethral resection of the prostate and are superior to those of medical management. Retreatment after transurethral resection of the prostate emerges because of complications following the procedure, whereas retreatment after transurethral microwave thermotherapy is as a result of treatment failure. In addition, the rate of failure of medical management is almost seven times higher than that for transurethral microwave thermotherapy. Thus, the latter seems to play a dominant role in the economic models used to assess the cost-efficiency of different treatment modalities for benign prostatic hyperplasia.

SUMMARY

The recent innovations in high-energy transurethral microwave thermotherapy provide better and more durable clinical outcomes and lower morbidity, and strengthen its position as an established treatment for benign prostatic hyperplasia. However, there is always room for improvement, so further research on therapeutic protocols, treatment monitoring and selection criteria are to be welcomed.