Enlarged Prostate and TUMT: "Dear DoctorInternet - Enlarged Prostate and TUMT
(February 3, 2001)
B.G. 'Although I underwent a TUMT six months ago I have not appreciably improved despite early signs of stronger urine flow. Whether this is due to age (69 years) or reduced bladder capacity or prostate restrictions I don't yet know. The answer would be very helpful.'
DoctorInternet. First some background. TUMT stands for 'TransUrethral Microwave Thermotherapy to prostate'. This is a minimally invasive treatment which aims at alleviating the difficulty in urination which is associated with non-malignant, enlarged prostate or Benign Prostatic Hypertrophy (BHP). The treatment causes a destruction of prostatic tissue by microwave heating and thus relieves the constriction around the urethra which causes the difficulty with urination. Although most, minimally invasive treatments for this condition seem to be abandoned after controlled studies, TUMT has survived as a common practice in urology. The more direct procedure and 'gold standard' is 'Transurethral Resection of the Prostate' (TURP) - a surgical technique, which requires greater technical skill, is more expensive, and can have more adverse effects. Other treatment options include: watchful waiting, balloon dilation, prostatic stent, medication (such as finasteride and terazosin), and the herb, serenoa repens. BPH is, essentially, inevitable with biological ageing. Over 50% of males over age 50 report varying degrees of the symptoms and by the age of 80, almost 90% have the underlying pathology.
Now, with respect to the particular question about why TUMT had only a transient benefit to the correspondent, studies have shown that, within the first year after treatment by TUMT, some 38% of the patients are dissatisfied with the results and that within 4 years after the procedure, the percentage who are dissatisfied increases to 77%. Thus, there is a high rate of only short term benefits. Other studies seem to show better and longer lasting results. As in most therapies, efficacy depends on the appropriateness of the treatment for the pathology of the particular person and the skill of the therapist. The procedure can be redone or alternatives attempted.
In addressing this inquiry, DoctorInternet exchanged e-mails with B.G., one of which was amusing. DoctorInternet to B.G. 'Incidentally, I forgot to ask your height and weight'. B.G. replied: 'My height is 5'10' and I weigh 210; and yes I already know, I'm too short'. (Bringing one's weight to its optimum improves virtually all disorders.)"
