Microwave thermotherapy for benign prostatic hyperplasia

Findings by SBU Alert

Version: 2

Technology and target group

Symptomatic benign prostatic hyperplasia (BPH) is common among older males. In transurethral microwave thermotherapy (TUMT) for BPH, a special catheter equipped with a microwave antenna is inserted in the urethra. The aim is to reduce the enlargement by using heat to destroy tissue in the prostate. An early variant of this treatment method (low-energy TUMT) was introduced in Sweden in the early 1990s. Many patients experienced an improvement in symptoms following treatment with low-energy TUMT, but little or no improvement was achieved in urinary flow. Further development in the treatment method, ie, high-energy TUMT, has made it possible to achieve higher temperatures in the prostate tissue and is intended to yield a better effect. Concurrently, the risks for side effects increase. In Sweden, various devices based on somewhat different techniques are available for performing high-energy TUMT. Treatment is generally delivered under local anesthesia on an outpatient basis. The target group consists mainly of patients with moderate prostatic enlargement. Even patients with more marked enlargement, where other diseases make them less appropriate for treatment with the standard method of transurethral prostatic resection (TURP), may be considered.

Patient benefit

Five randomized trials that compared high-energy TUMT with TURP reported relatively consistent results. Improvement in urinary flow was not as good with high-energy TUMT as it was with TURP. However, high-energy TUMT yielded equal improvement in symptoms. Treatment with high-energy TUMT required less care in hospital and was associated with fewer serious complications in comparison with TURP. However, after being treated with high-energy TUMT some patients may experience substantial problems from long-term catheter use, often resulting in irritative disorders. The risks for permanent side effects/complications following high-energy TUMT are not yet known.

Ethical aspects

Minor ethical implications are associated with the method. When making the decision to treat, it is essential to inform the patient that knowledge is limited concerning the benefits and risks of the method.

Economic aspects

There are no cost-effectiveness analyses that compare high-energy TUMT with TURP. The cost of treatment with high-energy TUMT is estimated to be approximately 23 000 Swedish kronor (SEK). An equitable comparison with TURP would require a followup period of at least 5 years.

Scientific evidence

There is good* scientific documentation concerning the effects of the method in the short term. There is poor* scientific documentation concerning patient benefits in the long term. From a patient perspective, however, it is unclear how to balance these effects. There is no* documentation concerning the cost effectiveness in relation to other current treatment methods.

Since information concerning the long-term effects and costs of the method remains insufficient, it is essential to develop this knowledge within the framework of studies.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Marianne Brehmer, MD PhD, Uppsala University Hospital. It has been reviewed by Assoc Prof Christer Dahlstrand, Sahlgrenska University Hospital, Göteborg and Lars Malmberg, MD PhD, Lund University Hospital.

The complete report is available only in Swedish.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

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