TURP, PVP show comparable efficacy in apples-to-apples trial

May 21, 2008

Men facing treatment for BPH can expect similar outcomes after transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP), according to results of a multicenter head-to-head comparison of the two treatments, presented at the AUA annual meeting.

Men facing treatment for BPH can expect similar outcomes after transurethral resection of the prostate (TURP) orphotoselective vaporization of the prostate (PVP), according to results of a multicenter head-to-head comparison of the twotreatments, presented at the AUA annual meeting.

The study compared results of 120 men randomized to undergo either TURP or PVP after evaluation, with follow-up evaluations at6 weeks and thereafter at 3, 6, and 12 months at centers in Ireland, the United States, and Australia. Increase in flow frombaseline, decrease in International Prostate Symptom Score (IPSS) from baseline, length of catheterization time (LOC), length of hospital stay (LOS), and percentagechange in prostate volume were compared within and between groups.

"TURP has stood the test of time for almost half a century. We wanted to see whether this new technology (PVP) could matchit," explained first author David A. Bouchier-Hayes, MD, of Galway Clinic, Ireland.

To eliminate expert bias, the procedures were limited to fellows or residents with between 35 and 350 TURP procedures amongthem, and little experience in performing laser prostatectomy. Because TURP is a difficult procedure, and the number of TURPcases is decreasing worldwide, the ability to offer a treatment option with comparable efficacy that did not demand superiorsurgical skills is important, Dr. Bouchier-Hayes told Urology Times.

Flow rate increased significantly (150%) from baseline in both groups (TURP: range, 5.2 to 33.3 mL/sec [mean+SD, 9.35+/-9.27];PVP: range, -10.1 mL/s to 33.2 mL/s [11.16+/-8.8]; p<.00005). Decrease in IPSS frombaseline also was significant (55%) for both groups (TURP: range, -4 to 32 mL/sec [mean+SD, 13.4±9.5]; PVP: range, -7 to31 mL/sec; [mean+SD, 14.7±8.4]; p<.00005). Decrease in prostate volume also was comparable.

The side-by-side comparison of outcomes told a different story. No significant differences were seen in increases in flow rateand decreases in 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 - 1 to 4 days compared with 2 to 9 days for theTURP group - and time to removal of the catheter: 0 to 56 days for PVP versus 16 to 192 days for TURP (bothp<.00005). In addition, adverse events such as blood loss and transfusion events were less frequent in men whounderwent PVP.

When counseling patients about the two procedures, "you can tell the patient that there is complete, randomized data thatshows there is no difference between these two procedures in terms of decreasing symptoms and improving flow rate, but withPVP, their blood loss, time of catheterization, and time in the health system will be less, and that has been validated in astudy," Dr. Bouchier-Hayes said.