TRANSURETHRAL HYPERTHERMIA FOR BENIGN PROSTATIC HYPERPLASIA - LONG-TERM RESULTS

Transurethral resection of the prostate (TURF) is the only recognized treatment in patients with benign prostatic hyperplasia (BPH). Transur ethral hyperthermia (TUHT) was used as an alternative treatment in pat ient who refused TURP. From 1987 to 1988, 21 BPH patients with moderat e to severe symptoms and signs of prostatism were treated with TUHT in a phase I trial. Mean pre-treatment subjective and objective values w ere: total symptom score (TSS) 13.5, obstructive symptom score (OSS) 6 .5, irritative symptom score (TSS) 7.0, peak flow rate (PFR) 11.6 cc/s ec, post-voiding residual volume (PRV) 187 cc, and prostate volume (PV ) 93 cc. TUHT was given for a total of 177 sessions (mean 8.4), each o f 60 min duration at a steady state. Temperature was recorded continuo usly on the urethral surface, in all treatments. It ranged from T-min 40.3 degrees C to T-max = 49.2 degrees C and T-mean = 44.1 degrees C. The mean minimum temperature of greater than or equal to 42 degrees C was obtained in 98 % of the TUHT sessions. Treatments were given on an outpatient basis without sedation or anaesthesia. Treatment tolerance was excellent with minor acute toxicity common (71% of patients), of no clinical importance and with no late complications. Of the 21 patie nts treated, 17 (81%) had an objective and 15 (71%) a subjective impro vement recorded at 6 months post-treatment. This statistically highly significant improvement included: 61% decrease in TSS; 66% decrease in OSS; 55% decrease in ISS; 42% increase in PFR: 55% decrease in PRV; a nd 21% decrease in PV. Of the 17 patients with objective improvement, nine have maintained their response to TUHT for a minimum period of ov er six years, two relapsed at 11 and 40 months, respectively, and six patients died of cardiovascular causes maintaining their response to d eath. This study has demonstrated TUHT treatment efficacy with no majo r or clinically important toxicity in BPH patients. A relative weaknes s of this report is a lack of verification of objective study paramete rs in the patients at seven years post-treatment. Prospective randomiz ed trials are needed to define the role of TUHT in the management of B PH patients.