Transurethral resection of the prostate, photoselective vaporization of the prostate show similar efficacy in head-to-head trial

September 1, 2008

Men facing treatment for benign prostatic hyperplasia can expect similar outcomes after transurethral resection of the prostate or photoselective vaporization of the prostate.

The study compared results of 120 men randomized to undergo either TURP or PVP after evaluation, with follow-up evaluations at 6 weeks and thereafter at 3, 6, and 12 months at the Royal Melbourne Hospital, Australia. At baseline, patient demographics were representative of those of the general population: ≥50 years of age, flow rate <15 mL/second, International Prostate Symptom Score (IPSS) >11, and no detectable prostate cancer.

Increase in flow from baseline, decrease in IPSS from baseline, length of catheterization time (LOC), length of hospital stay (LOS), and percentage change in prostate volume were compared within and between groups.

To eliminate expert bias, the procedures were limited to fellows or residents with between 35 and 350 TURP procedures among them and little or no experience in performing laser prostatectomy. Because TURP is a difficult procedure and the number of TURP cases is decreasing worldwide, the ability to offer a treatment option with comparable efficacy that did not demand superior surgical skills is important, Dr. Bouchier-Hayes told Urology Times.

"We wanted a relatively straightforward skill transfer," he said.

Significant benefits

Flow rate increased significantly (150%) from baseline in both groups. In the TURP group, flow rates increased from 8.9±2.99 mL/s (range, 3.1-15) preoperatively to 19.37±8.67 mL/s (range, 7.2-40.9) mL/s at 12 months in PVP patients; flow rates increased from 8.8±2.6 mL/s (range, 4-14.3) preoperatively to 18.6±8.2 (range, 1.7-43.1) for a value of 10.02 mL/s (136%, p<.0000001).

Decrease in IPSS from baseline also was significant (~55%) for both groups. IPSS in TURP patients decreased from 25.4±5.7 (range, 14-35) to 11.7±10.0 (range, 0-35) for a numerical decrease of 13.5 (53%, p<.0000001) at 12 months. In PVP, scores dropped from 25.27±5.93 (range, 13-35) preoperatively to 8.86±7.6 (range, 1-35) for a numerical drop of 15.5 (61%, p<.0000001) at 12 months. Decrease in prostate volume also was comparable.

The side-by-side comparison of outcomes told a different story. No significant differences were seen in increased flow rate or decreased IPSS from baseline between the two groups. Percentage change in prostate volume also was not significant.

However, men treated with PVP had significantly shorter hospital stays and time to removal of the catheter. Mean stay in the PVP group was 1.09 days (range, 1-2) and the mean for the TURP group was 3.28 days (range, 3-9). Mean time to catheter removal in the PVP group was 13.8 hours (range, 0-56) versus 44.2 hours for TURP (range, 6-192) (p<.0000001). In addition, adverse events such as blood loss and transfusion events were less frequent in men who underwent PVP. Consequently, cost of PVP is 22% less than that of TURP under a socialized healthcare system, such as Australia's.

"As a practicing urologist, you can now tell the patient that there is complete, randomized data that shows there is no difference between these two procedures in terms of decreasing symptoms and improving flow rate, but with PVP, their blood loss, time of catheterization, and time in the health system will be less, and that has been validated in a study," Dr. Bouchier-Hayes advised.