Lower-energy thermotherapy in the treatment of benign prostatic hyperplasia: long-term follow-up results of a multicenter international study

Abstract

The purpose of the present study was to evaluate the long-term results of lower-energy transurethral microwave thermotherapy (TUMT) and to determine predictors for a favorable treatment outcome in an international multicenter study. A total of 1092 patients treated between April 1990 and September 1993 in 6 different centers in different countries were evaluated. All patients were treated in a nonblinded, noncontrolled fashion with the Prostatron thermotherapy device using the lower-energy treatment protocol Prostasoft 2.0. Collected data included voiding parameters, Madsen symptom scores, retreatments, types of retreatment, and dates of retreatment. Instrumental retreatment served as the end point for further evaluation. The average age of our patients was 67 years. At baseline the average uroflow rate was 8.7 ml/s. After treatment the improvement in uroflow was 2-3 ml/s. This was maintained for up to 5 years after treatment for the patients remaining in follow-up. The overall improvement in the Madsen symptom score was 5-6 points for these patients. There was no significant difference between the different centers. During follow-up, however, the number of patients remaining in follow-up decreased rapidly. The absolute instrumental retreatment rate appeared to be 26%; however, when patients no longer in follow-up were taken into account, the calculated retreatment rate was 39.6% (Kaplan-Meier survival analysis). Patients undergoing retreatment were younger at baseline and had a higher Madsen score, a bigger prostate, and a greater postvoid residual. No major complication was seen. Lower-energy TUMT gives a sustained objective and subjective improvement in patients with moderate symptoms and a low-grade bladder outflow obstruction. Patients with bigger prostates, severe symptoms, low rates of maximal uroflow, and large residuals are prone to have a higher degree of prostatic obstruction and are not the ideal candidates for this treatment. The absolute instrumental retreatment rate after 5 years was 26%. Moreover, no significant international difference in treatment outcome was found.

Transurethral Microwave Thermotherapy for Symptomatic benign Prostatic Hyperplasia: Long–Term Durability with Prostcare

“…Eliasson et al [10]and De Wildt et al [12]reported that no baseline routine clinical parameter is capable of predicting treatment outcome between responders and nonresponders. In contrast, both Keijzers et al [4]and Francisca et al [7]found that patients who were younger, and had higher symptom scores and lower peak uroflow rates at baseline, had a significantly higher retreatment rate, particularly receiving instrumental or invasive surgery. For prostate volume, there is some equivocation in the literature [4, 7, 11, 13].…”

“…In contrast, both Keijzers et al [4]and Francisca et al [7]found that patients who were younger, and had higher symptom scores and lower peak uroflow rates at baseline, had a significantly higher retreatment rate, particularly receiving instrumental or invasive surgery. For prostate volume, there is some equivocation in the literature [4, 7, 11, 13]. In our study, there were no significant differences according to the patients’ age, symptom score, IPSS, peak uroflow rate or prostate volume among patients requiring no further therapy, receiving endoscopic surgery and medication.…”

“…According to previous published reports, the overall retreatment rates ranged from 31 to 58% with various devices, including 17–36 with instrumental or invasive surgery and 6–41% with medication (table 3) [3, 4, 5, 6, 7, 8]. This means that approximately one third to one half of these patients eventually receive an additional treatment within 5 years after lower–energy TUMT.…”

“…This may imply that some patients were concerned about the complication or risk of TUR–P or unwilling to undergo general or spinal anesthesia. Interestingly, there were a few patients (6.1%) who chose another session of TUMT during follow–up [7], but the results of re–TUMT have not been reported yet.…”

“…The advantages of TUMT include the use of local anesthesia only, no blood loss, no or minimal influence on erection or ejaculation despite a higher incidence of urinary retention following thermotherapy [2]. Despite numerous studies unequivocally supporting efficacy and safety of TUMT for treatment of symptomatic BPH, several reports have questioned the long–term durability of low–energy TUMT (LE–TUMT) with overall retreatment rates either instrumentally/invasively or pharmocologically at 3–5 years following thermotherapy ranging from 31 to 58% with various devices [3, 4, 5, 6, 7, 8]. However, to our knowledge, there has been no report to date covering the long–term durability of TUMT with Prostcare in the literature.…”