Evaluation of benign prostatic enlargement treatments
News release from the National Coordinating Centre for Health Technology Assessment
24 October 2008
Research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has found that Transurethral Resection (TURP), the most common operation for Benign Prostatic Enlargement (BEP), remains to be the most clinically and cost-effective treatment. BEP commonly causes older men to have difficulty passing urine and may require surgery to alleviate the problem.
Researchers at the University of Aberdeen, led by Professor James Michael Olu N'Dow, examined existing data to determine the risk factors and clinical and cost-effectiveness of alternative treatments for BEP to help identify areas for future research. These included ‘minimally invasive’ and ‘tissue ablative’ treatments such as: the surgical removal of tissue of the prostate (TURP); Transurethral Needle Ablation (TUNA); Holmium laser enucleation of prostate (HoLEP); and non-surgical minimally invasive techniques including laser coagulation (TEAP), microwave therapy, and laser transurethral vaporisation (TUVP). They also looked at the overall long term benefits to patients.
Methods similar to TURP require an anaesthetic, stay in hospital, and can sometimes lead to unwanted side effects such as bleeding. However, some patients do not require general anaesthetic and treatment can be performed within an out patient department using alternative procedures. Newer procedures have been developed but there is uncertainty about their clinical and cost-effectiveness. Treatments like TUNA, which uses radio waves to heat and destroy the part of the prostate that’s blocking urine flow, and HoLEP, which is unique amongst the newer technologies offer some advantage over TURP although long-term follow-up data is needed.
The research team concluded that the rate of incontinence was similar across all interventions and patient’s general recovery was more rapid with clinical surgery, and it gave better long term results with less need for additional treatment. However, further data may be required as the majority of respiratory clinical trials had less than 100 participants included in the report. They also found that TUNA relieves symptoms more effectively than medications do, but less effectively than traditional prostate surgery and it is not always sufficiently effective for men with very large prostates.
Professor Olu N’Dow says, “The minimally invasive procedures may not be appropriate until a more effective or less costly technology is available as it was sometimes found that further intervention was required due to unsatisfactory urinary flow rate. Our team recommends a need for further research to determine how many years of medical treatment are necessary to offset the cost of treatment with minimally invasive or ablative intervention.”
To view full details about the project visit www.hta.ac.uk/1468
Notes for editors
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The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10 per cent of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
- The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
Contact details
Naomi Stockley, Programme Manager (Communications)
Telephone: 02380 595 646, Email: ns5@soton.ac.uk
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Telephone: 02380 595 584, Email: h.nikandrou@soton.ac.uk
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