Dr. McVary discusses early promise with Rezum in large prostates

Commentary
Video

“Overall, I'd say these shorter-term outcomes at 6 months look to be very similar to those outcomes measured with the smaller glands. In a sense, at least within this range, volume may not be a deal breaker,” says Kevin T. McVary, MD.

In this video, Kevin T. McVary, MD, discusses key findings from the study, “Water vapor thermal therapy in men with prostate volume ≥80 cm3: A systematic review and meta-analysis,” for which he served as the lead author. McVary is a professor of urology and the director of the center for male health at Loyola University Medical Center in Chicago, Illinois.

Video Transcript:

In our study, I think [the] average [prostate] was 109 grams. So these are much larger than 80. The type of symptom improvement that we see in our patients is clinically significant, it's clinically important, and it's very similar to the type of response we would see in prostates in the smaller, more traditional volume limited size [of] 30 to 80 grams. So, it's very similar to that. Second, surgical retreatments were exceedingly low, 1.5%, which is very good and very competitive, not just to the other MISTs in the field, but very similar to what we saw in the pivotal trial. The complications were very low, less than 0.1%. So, very low serious complications. And when you write those 1, 2, 3, 4, the 3s and 4s were absent. It safe to push the envelope; at least the evidence looked that way. And as I mentioned, the clinical outcomes, and by that, I mean the IPSS–the International Prostate Symptom Score, the AUA symptom index, these are synonymous–those symptom improvements were very similar to the smaller, previously reported outcomes. The quality of life improvement, also very similar. The impact on sexual function based on IIEF, or Shim, these are questionnaires that we use to measure erectile dysfunction and its severity. There was no change, meaning that there's no measurable impact on sexual function. So, that was all good news. Post void residuals also dropped substantially between pre- and post-treatment. And again, very similar to the range we would see when we look at the more standard size assessments. So, that was all good.

The average follow-up in this larger prostate cohort was 6 months; it ranged from 3 months to 17 months in the papers that we reviewed for the meta-analysis. So, that's okay. I mean, that gives you a nice estimate of what you expect to see, but 6 months is not 6 years. So, again, that just leaves the door open about [the] need to explore this, because there might be some real patient benefits. So, I'd say that's pretty reasonable. Overall, I'd say these shorter-term outcomes at 6 months look to be very similar to those outcomes measured with the smaller glands. In a sense, at least within this range, volume may not be a deal breaker. Again, that's a meta-analysis. It's not the same as having a control group, a randomized trial. We'd always like to see that kind of information. But at any rate, it I think it supports investigating this further. Certainly, the signal is all green lights, no red lights, no even yellow flashing lights. It looks pretty good.

This transcription has been edited for clarity.

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