Responders and Non-Responders to Treatment of Benign Prostatic Hyperplasia with Transurethral Microwave Thermotherapy

Abstract

One hundred and seventy two patients with benign prostatic hyperplasia (BPH) were treated with transurethral microwave thermotherapy (TUMT) using Prostcare (Bruker Spectrospin). The treatment was performed with an effect of 52 W and a frequency of 915 MHz, which was generally well tolerated and no serious side effects were observed. In the majority of the patients there was an improvement of subjective symptoms with a significant decrease in Madsen and bothering scores after treatment. In the total patient group, Qmax and voided urine volume were increased slightly, but not statistically significantly. The patients were divided in responders and non-responders, based on Madsen symptom score after 3 months or if complementary treatments were necessary during the follow up period of one year. No significant differences between the groups were observed regarding pretreatment variables except that patients in the responder group experienced the treatment more painful than non-responders. Qmax in the responder group was significantly improved at 6 and 12 months follow up. PSA levels increased significantly after the treatment. Routine evaluation using flow rate, estimation of prostatic size, measurement of residual urine volume and cystoscopy does not give sufficient information for predicting treatment outcome.

Transurethral Microwave Thermotherapy for Symptomatic Benign Prostatic Hyperplasia: Short-Term Experience with Prostcare

“…This emission is interrupted for 6 s every minute to carry out radiometric measurements for controlling the treatment. The water circulation is maintained at 20°C for urethral cooling [8,9]. In our experience, Tandem-E ® immunoenzymometric assays (Hybritech, San Diego, Calif., USA) were used for PSA analysis.…”

“…Despite numerous studies with various devices supporting efficacy and safety of TUMT for treatment of symptomatic BPH, only a few studies have reported the results with the Prostcare apparatus for TUMT [8,9]. The objective of this study was to describe safety and efficacy of TUMT with Prostcare for symptomatic BPH.…”

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

“…Our results showed that most patients (75%) were initially satisfied within the initial 3 months, but the efficacy slightly decreased at 6 months, and was maintained up to 12 months as reported by Eliasson et al [10]. Therefore, this prompted us to evaluate the long–term durability of TUMT with Prostcare for symptomatic BPH.…”

“…Therefore, as with other devices, it is very important to understand which factors can predict the outcome after TUMT. 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.…”

Elevation of sensory thresholds in the prostatic urethra after microwave thermotherapy

“…Such treatment causes little or no reduction in the volume of prostatic adenomas [5], and thus it has been proposed that TUMT induces denervation, which in turn diminishes the tension in the smooth muscle cells of the prostate, similar to a-adrenergic receptor blockade [6,7]. In a previous study [8] TUMT substantially decreased the number of nerve ®bres in the smooth muscle layer of the periurethral prostatic tissue, even when there was no necrosis deeper in the prostate gland.…”