Globally, more than 110 million men suffer from benign prostatic hyperplasia (BPH), a condition associated with frequent urination during the day and night, trouble urinating, and/or urinary retention. According to the American Urological Association (AUA), the prevalence of BPH by the time a man reaches age 60 is higher than 50%. By the time they reach age 85, the prevalence jumps to as high as 90%. If left untreated, BPH can lead to bladder stones, urinary tract infections, and kidney failure.
Medications effectively treat symptoms for most men with BPH, but surgery can be used as a last resort for severe cases. Several surgical procedures are available for BPH, the most common being transurethral resection of the prostate (TURP). Although TURP has been shown to be safe and effective, there are surgical risks and patient preferences to consider. TURP has been associated with long hospitalizations, catheterizations, and recovery times.
Advancing Science on Laser Therapy
At the 2013 AUA annual meeting, data were presented on the GOLIATH study, a head-to-head study involving TURP and laser therapy. The prospective, multicenter, randomized trial compared TURP and photoselective vaporization of the prostate (PVP) using the 180W GreenLight XPS system (American Medical Systems, Inc.). According to the results, PVP provided several advantages to TURP for addressing lower urinary tract symptoms associated with BPH.
The GOLIATH study demonstrated that PVP was equivalent to TURP with regard to safety and efficacy, as evidenced by the number and rate of adverse events and by the International Prostate Symptom Score and Qmax score (which reflects peak urinary flow rate). PVP was superior to TURP with regard to recovery time, including shorter catheterization times, shorter hospital stays, and a faster return to a stable health status. Significantly lower rates of short-term re-intervention and fewer bleeding and dysuria events were also observed with PVP. Prostate tissue volume and PSA reduction rates were similar between PVP recipients and those receiving TURP.
Laser Therapy for BPH: Looking Forward
With 10 years of experience using laser therapy for BPH patients, the data from GOLIATH came as little surprise and confirmed what urologists have been seeing in clinical practice for several years. The study results demonstrate why many patients are choosing laser therapy as an alternative to TURP. In addition to being well tolerated and safe, PVP is a viable alternative for many patients because it treats all gland sizes and can be used in those taking anticoagulants, as well as older, sicker patients. It offers patients a chance to go home without a catheter and quicker convalescence.
Readings & Resources (click to view)
For a white paper from American Medical Systems titled “Clinical Outcome Comparison of GreenLight KTP-532 Laser (80 W) Prostatectomy Versus Transurethral Resection of the Prostate (TURP),” go to http://www.amsgreenlight.com/documents/GreenLight_GLvsTURP_whitepaper.pdf
Hueber P, Liberman D, Ben-Zvi T, et al. GreenLight HPS-120W vs GreenLight XPS-180W laser vaporization of the prostate for BPH: a global multi-center, and prospective comparative analysis according to prostate size. Poster presentation. AUA Annual Meeting. San Diego, CA. May 2013.
Albino G, Marucco EC. TURP and PVP treatments are really similar? From subjective feeling to objective data. Pilot study (proof of concept) prospective randomized trial. Arch Ital Urol Androl. 2012;84:220-223.
Teng J, Zhang D, Li Y, et al. Photoselective vaporization with the green light laser vs transurethral resection of the prostate for treating benign prostate hyperplasia: a systematic review and meta-analysis. BJU Int. 2013;111:312-323.
Elhilali MM. Overview of interventional treatment options for benign prostatic hyperplasia. Can Urol Assoc J. 2012;6(Suppl):S143-S145.
Ding H, Du W, Lu ZP, Zhai ZX, Wang HZ, Wang ZP. Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis. Asian J Androl. 2012;14:720-725.
Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012;79:1111-1116.