Abstract: PD27-02
Sources of Funding: None

Introduction

First-line therapy for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (LUTS/BPH) is medical therapy. Convective radiofrequency water vapor energy ablation of prostate has shown promising intermediate-term results for LUTS/BPH. This study compared results of WaVE ablation of prostate with a historical cohort receiving combination medical therapy from the NIDDK sponsored Medical Therapy of Prostatic Symptoms (MTOPS) study.

Methods

Results from the treatment arm of a double-blinded, randomized, controlled trial investigating WaVE ablation of prostate were compared to the results of the MTOPS combination therapy arm, receiving both doxazosin and finasteride, restricted only to those subjects with prostate volume 30cc or lager and IPSS 13 or worse. IPSS, BPH Impact Index (BPHII), Qmax, and PVR were compared at 3 months, 6 months, 1 year, and 2 years. Propensity score weighting was also performed to eliminate differences in IPSS, QOL and prostate volume between the groups at baseline and outcomes were again assessed at 3 months, 6 months, 1 year, and 2 years.

Results

129 and 386 subjects were in the WaVE and MTOPS cohorts, respectively. Baseline characteristics show similar age (63.3, 63.1, p = 0.73), BMI (28.7, 28.1, p = 0.17), IPSS (21.5, 19.4, p < 0.001), Qmax (9.9, 10.3, p = 0.17), and PVR (82, 73.2, p = 0.16). The WaVE cohort had lower PSA (2.1, 2.6, p = 0.0033), larger prostate volume (46, 37.8, p < 0.0001), and worse QOL (4.4, 3.3, p < 0.0001). Following treatment the WaVE cohort was significantly better than the MTOPS cohort at all time points in improvement in IPSS and BPHII. Change in Qmax was not significantly different between the two groups. Propensity score weighted analysis showed no difference in IPSS or BPH Impact Index at all time points. Qmax was greater in the WaVE cohort in the first year but was similar at 2 years. PVR was significantly improved in the MTOPS cohort from 6 months through 2 years.

Conclusions

WaVE prostate ablation has similar early and intermediate-term outcomes as combined medical therapy does for treatment of LUTS/BPH when adjusted for propensity score. Primary treatment decision may depend on discussion of adverse events and medication burden. Longer-term follow-up is necessary to assess the durability of WaVE prostate ablation.

Funding

None