Prospective randomized comparison of high energy transurethral microwave thermotherapy versus alpha-blocker treatment of patients with benign prostatic hyperplasia

Purpose: We compare directly the efficacy and safety of targeted high energ y transurethral microwave thermotherapy with ar-blocker treatment for benig n prostatic hyperplasia (BPH). Materials and Methods: In this randomized prospective study 52 patients wit h symptomatic BPH received terazosin and 51 underwent high energy transuret hral microwave therapy with topical anesthesia. Patient evaluation included determination of International Prostate Symptom Score (I-PSS), peak flow r ate and quality of life score before transurethral microwave therapy or ter azosin and periodically up to 6 months thereafter. Results: At 2-week followup the terazosin group transiently exhibited signi ficantly greater improvement than the transurethral microwave therapy group in mean values of all 3 primary efficacy parameters of I-PSS, peak flow ra te and quality of life score. At 12 weeks and 6 months this pattern was rev ersed, and the transurethral microwave therapy group achieved significantly greater improvement than the terazosin group in mean I-PSS, peak flow rate and quality of life score. By 6 months 78.4, 64.7 and 84.3% of the transur ethral microwave therapy group demonstrated a 50% or greater improvement in I-PSS, peak flow rate and quality of life score, respectively, compared wi th 32.7, 9.6 and 40.4% of the terazosin group, respectively. Nine patients in the terazosin group and 1 in the transurethral microwave therapy group w ithdrew from study because of side effects or lack of treatment efficacy. Conclusions: Terazosin afforded more rapid improvement in symptoms, voiding function and quality of life in BPH patients. High energy transurethral mi crowave therapy offered markedly superior clinical outcomes at 12 weeks to 6 months.