Targeted transurethral microwave thermotherapy versus alpha-blockade in benign prostatic hyperplasia: Outcomes at 18 months

Objectives. To compare directly the efficacy, safety, and durability of tar geted transurethral microwave thermotherapy with that of alpha-blocker trea tment for lower urinary tract symptoms of benign prostatic hyperplasia. Methods. In a randomized, controlled clinical trial, 52 patients with lower urinary tract symptoms due to benign prostatic hyperplasia received terazo sin treatment and 51 underwent microwave treatment under topical anesthesia . The patient evaluation included the International Prostate Symptom Score, peak flow rate, and quality-of-life score before microwave treatment or in itiation of terazosin treatment and at periodic intervals thereafter up to 18 months. Results. The mean International Prostate Symptom Score, peak flow rate, and quality-of-life score all improved significantly in both groups by 6 month s. However, the magnitude of improvement was significantly greater in the m icrowave group than in the terazosin group. The significant between-group d ifferences observed at 6 months in the mean International Prostate Symptom Score, peak flow rate, and quality-of-life score were fully maintained at 1 8 months, at which time the improvements in these three outcome measures we re significantly greater (P <0.0005), by 35%, 22%, and 43%, respectively, i n the microwave group than in the terazosin group. The actuarial rate of tr eatment failure at 18 months was significantly greater by sevenfold in the terazosin group. Adverse events were generally infrequent and readily manag eable in both groups. Conclusions. Although the initial onset of terazosin action was more rapid, the longer term clinical outcomes of targeted microwave treatment were mar kedly superior. The more favorable results in patients who underwent microw ave treatment were maintained for at least 18 months. UROLOGY 57: 66-70, 20 01. (C) 2001, Elsevier Science Inc.