1: Radiofrequency water vapour thermal energy: a potential new treatment for benign prostate hyperplasia
A multi-centre American trial has just reported the three-year outcomes of a new, minimally invasive treatment for benign prostate hyperplasia (BPH). This new procedure utilises convective radiofrequency (RF) water vapour thermal therapy, causing cell death without dessication, and has the advantages of a shorter heating time and lower required temperatures than conductive heat transfer methods.
197 men over the age of 50, with an international prostate symptom score (IPSS) equal to or over 13, a prostate volume of 30cc to 80cc, a maximum flow rate of less than 15 ml/s and a measured post-void residual urine volume of over 250ml were included in the study. Men with a PSA above 2.5ng/ml with a free PSA above 25% were excluded from study.
The men were randomly assigned 2:1 to thermal therapy (n=136) or a sham or control procedure with rigid cystoscopy (n=61), and were required to discontinue any BPH medication before treatment. A double-blind method was maintained for three months’ comparison of the RF and control treatments, after which 53 of the 61 patients undergoing the control procedure opted for the RF treatment. Data was subsequently compared to patient-reported baseline values.
At the 3 month treatment follow-up period, IPSS was significantly improved in the RF-treated patients compared to the control group (p<0.0001), and the early response of a 50% improvement in IPSS was consistently sustained at this level throughout the three years of follow-up. Similarly, there were corresponding and durable improvements in urinary flow rate, quality of life and incontinence compared to baseline results (p<0.0001), although the increased urinary flow of >50% from three-to-24 months reduced to a reported 39% improvement at the 36-month follow up.
Sexual function was preserved in patients, with erectile function improved in 16% of sexually active patients at the 36-month follow up point. Reported adverse events were infrequent and of short duration: the most commonly reported event was dysuria (16.9%), haematuria (11.8%), frequency and urgency (5.9%), acute urinary retention (3.7%) and suspected urinary tract infection (3.7%). All were treated routinely or resolved without treatment within three weeks. Surgical retreatment was at 4.4% over the three-year follow-up period and primarily related to the failure to initially treat the median lobe in four (3%) of the 135 patients.
Analysis by the study group showed RF to be more cost-effective than TURP, and another advantage of the treatment is that it doesn’t require inpatient hospitalisation. However, the retreatment rate and longer-term efficacy of RF treatment will have to be compared to other BPH surgical treatments before it could be suggested as a first-line therapeutic option for men.