What are the advantages of prostate ablation over surgical intervention for benign prostatic hyperplasia (BPH)?

From the Guidelines

Prostate ablation is often considered better than surgery for benign prostatic hyperplasia (BPH) because it offers several significant advantages, including less invasiveness, shorter recovery times, and reduced risk of complications. Ablation procedures, such as transurethral needle ablation (TUNA) and transurethral microwave heat treatments, are effective in partially relieving symptoms of BPH, as shown in studies 1. These procedures can be performed on an outpatient basis, allowing patients to return home the same day, and they preserve sexual function better than surgery, with lower risks of retrograde ejaculation and erectile dysfunction.

Some of the key benefits of prostate ablation over surgery include:

• Less bleeding, making them suitable for patients on blood thinners or with bleeding disorders
• Fewer urinary incontinence issues compared to surgical approaches
• Quicker return to normal activities
• Effective alternative with fewer side effects for patients with moderate BPH symptoms who want to avoid the risks of traditional surgery. According to the AUA guideline on management of BPH, patients who have developed complications of BPH are best treated surgically 1, however, for those with moderate symptoms, ablation techniques offer a viable option.

From the FDA Drug Label

The results of MTOPS are consistent with the findings of the 4-year, placebo-controlled study A Long-Term Efficacy and Safety Study [see CLINICAL STUDIES (14. 1)] in that treatment with finasteride tablets reduces the risk of acute urinary retention and the need for BPH-related surgery. In MTOPS, the risk of developing acute urinary retention was reduced by 67% in patients treated with finasteride tablets compared to patients treated with placebo (0.8% for finasteride tablets and 2. 4% for placebo). Also, the risk of requiring BPH-related invasive therapy was reduced by 64% in patients treated with finasteride tablets compared to patients treated with placebo (2.0% for finasteride tablets and 5.4% for placebo). 1.1 Monotherapy Finasteride tablets are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:

• Improve symptoms
• Reduce the risk of acute urinary retention
• Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.

The FDA drug label does not answer the question.

From the Research

Comparison of Prostate Ablation and Surgery for Prostate Hyperplasia

• Prostate ablation is considered a minimally invasive alternative to traditional surgical methods such as transurethral resection of the prostate (TURP) for treating benign prostatic hyperplasia (BPH) 2, 3, 4, 5.
• Studies have shown that prostate ablation techniques, such as microwave thermotherapy, can improve symptom scores and peak urinary flow, although the extent of improvement may vary compared to TURP 2.
• The advantages of prostate ablation include decreased risks of complications such as retrograde ejaculation, treatment for strictures, hematuria, blood transfusions, and the transurethral resection syndrome, but may increase the risk of dysuria, urinary retention, and retreatment for BPH symptoms 2.
• Laser prostate ablation and enucleation are also considered minimally invasive techniques, with distinct practice patterns and outcomes in a national cohort, including differences in patient selection, intraoperative factors, and postoperative complications 6.

Efficacy and Safety of Prostate Ablation

• Prostate ablation techniques have been shown to be effective in improving symptom scores and peak urinary flow, with some studies demonstrating improvements comparable to TURP 2, 4.
• The safety of prostate ablation has also been demonstrated, with decreased risks of complications compared to traditional surgical methods 2, 3, 5.
• However, the long-term efficacy and safety of prostate ablation techniques require further study, with some studies suggesting that the durability of effect may vary depending on the specific technique and patient population 5.

Current Status and Future Directions

• Prostate ablation is considered a viable alternative to traditional surgical methods for treating BPH, with ongoing research aimed at improving techniques and outcomes 4, 5.
• The development of new minimally invasive therapies, such as mechanical and thermo-ablative strategies, is ongoing, with some studies demonstrating promising results 4, 5.
• Further study is required to define the role of minimally invasive surgical therapies in the treatment of BPH and to determine the long-term efficacy and safety of these techniques 5.