Microwave Therapy

PROSATE MICROWAVE THERAPY

Just What the Doctor Ordered

What's the ideal treatment for prostate problems? The treatment should be safe, effective, painless, long lasting, noncomplicatied and inexpensive. While the perfect treatment does not exist, microwave thermotherapy represents a significant advancement in prostate care. Symptoms of prostate problems may include slowing of the urine stream, stuttering of the urine stream (unwanted stopping, restarting, stopping, restarting), frequent urinating, urgent urinating, nighttime urinating and incomplete bladder emptying. These symptoms are known to doctors by the term "lower urinary tract symptoms" or "LUTS". In men, these symptoms are commonly related to the prostate. When the urologist determines that the symptoms are not being caused by cancer, inflammatory/infectious diseases or neurological disease, a benign prostate condition may be to blame.

The old standard surgical treatments for benign (non cancerous) prostate enlargement are transurethral resection of the prostate (TURP) and simple open prostatectomy. These operations involve surgical removal of the inner portion of the prostate through either through a scope-like instrument placed through the urethra (TURP) or by means of an open surgical incision though the skin (open prostatectomy). While these surgeries have very high rates of success, these surgeries are always associated with bleeding, always require a trip to the operating room, always require anesthesia, always require a catheter and usually require a hospital stay. These operations are often reserved for men with very large prostates and clear indications for surgery such as bleeding from the prostate, kidney problems caused by the prostate or total inability to urinate (urinary retention). After surgery, pain may be mild; however, patients are restricted from performing any significant physical activity for a period of at least six weeks. Patients who fail to follow these activity restrictions often experience heavy blood in the urine which sometimes clots, resulting in the complete inability to urinate and the necessity for emergency catheter replacement.

... minimally invasive techniques ... offer the potential for fewer side effects [of treatment] as compared to TURP.

In order to avoid hospitalization, restriction of activity, catheterization, bleeding, and operating room surgery, minimally invasive prostate treatments options have been developed. The most widely used non-surgical prostate procedure is transurethral microwave thermotherapy (TUMT). This technology is approved by the FDA and the physicians at the Urology Center have been using this technology to provide relief of prostate symptoms for over 5 years. TUMT offers a simple alternative to surgery, while providing symptom relief generally beyond that of medication. The American Urological Association's Clinical Guidelines document states that microwave therapy (TUMT) "...is more effective than medical therapy (medications) but less effective than surgery in relieving (urinating) symptoms." In a recent review of our TUMT (microwave) patients, results have been impressive. More than 95 percent of patients reported improvement of symptoms after the office TUMT procedure, with many patients reporting near complete relief.

At the Urology Center there are two microwave options... TherMatrx DOT and Prolieve.

At the Urology Center there are two microwave (TUMT) options. The TherMatrx DOT procedure is designed to deliver effective treatment at lower microwave energy levels. DOT stands for "dose optimized thermotherapy." TherMatrx DOT delivers a variable dose of microwave energy which is tailored to patient comfort during the procedure. DOT remains the easiest and most comfortable of all of the minimally invasive prostate treatment options. Technologically advanced equipment allows the DOT procedure to be performed in the doctor's office at the Urology Center, without IV anesthesia and without injections of any kind. Patients receive oral medications to assure relaxation throughout the procedure. A local anesthetic jell is used to decrease sensation within the urethra at the time of treatment. Treatment is fast, about one hour, and patients may return home immediately. Some patients do require a catheter for a period of about 2-5 days but others do not.

The second and even newer microwave option at the Urology Center involves somewhat different technology. Boston Scientific Inc., a world leader in the manufacturing of medical appliances, has taken existing microwave technology and improved upon its original design by incorporating a unique prostate dilating device into the microwave delivery system. This new procedure is called Prolieve transurethral thermodilation. The new Prolieve microwave thermodilation system combines dilation of the prostate with microwave heating of the gland to achieve immediate results in most cases. The balloon dilation of the prostate allows most men to go without a catheter at all! Patients do receive oral medications to help with relaxation. A local numbing jell is also used to decrease sensation within the urethra at the time of Prolieve treatment. Treatment is fast, an hour or less, and patients may return home immediately, without a catheter in most cases.

Satisfaction rates are very high and most patients are pleased that they are eventually able to stop their alpha blocker prostate medications (Flomax, Cardura, Hytrin and others) and return to normal urinating habits. This procedure has been proven to be safe and effective with fewer side effects than the standard TURP surgery.

So what's the difference between various microwave treatments?

So what's the difference between various microwave treatments? Older generation microwave, including the so-called "cooled" microwave, is very often painful, requires more anesthesia and in a minority of cases has been associated with severe complications. However, doctors at the Urology Center use only the new generation microwave techniques and no patient has ever experienced any complication whatsoever.

The Prolieve microwave procedure uses a prostate dilating balloon and a higher power microwave generator. The DOT microwave procedure is lower power and does not use a dilating balloon. Prolieve produces results almost immediately and most men do not need a catheter after the procedure. The results of the higher power Prolieve procedure may one day prove to be longer lasting -- but this has not yet been proven to be the case. The DOT procedure is much easier for patients to tolerate but the results of the treatment may take longer to appreciate and a catheter may be required. Each has its advantages. At the Urology Center patients have choice. Physicians at the Urology Center help men make the best choice for each person's particular needs and desires. As of the time of this writing, the Urology Center is the only facility in this area which offers the DOT and Prolieve TUMT non-surgical microwave treatment options.

How do you know what is best for you?

How do you know what is best for you? First, determine the severity of the symptoms by answering a few questions. The standard questionnaire that most doctors use is called the American Urological Association Symptom Index (AUASI). Please click on the highlighted link, print and complete the questionnaire then return here.

If your AUASI score is less than eight or if your bother score is zero, see your urologist to to make sure that your symptoms are really due to a prostate problem. If the symptoms are shown to be caused by a very mild prostate problem, it may be best to simply observe or watch the situation, without using medication, surgery or minimally invasive treatments like microwave.

On the other hand, if your AUASI score is more than seven or if your bother score is one or higher, see your urologist to confirm that your symptoms are caused by the prostate. If so, examine the your goals of treatment. Please click on the highlighted link, print and complete the questionnaire then return here.

What have you learned about the severity of your symptoms and your goals of treatment? You may consider options such as simple observation without any treatment, herbal/natural supplements, lifelong medication use, alternative minimally invasive surgical treatments (TUNA, ILC, WIT), or even operating room surgery (TURP, TUIP, TVP, laser surgery, open surgery). However, if you do not care to go into the operating room for anesthesia and surgery, if don't like the idea of using a lifetime of prostate medications, if you cannot afford a lifetime of prostate medications, if you need a treatment covered by Medicare and most private insurance, office microwave treatment may be right for you.

... TherMatrx DOT and Prolieve microwave

... indeed are often, "just what the doctor ordered."

In summary, lower urinary tract symptoms secondary to benign prostate problems are easily treatable with medication and various surgeries. While no treatment can claim long-term generally good results of real surgery, minimally invasive office techniques, such as TherMatrx DOT and Prolieve microwave procedures indeed are often, "just what the doctor ordered."

(Also see related glossary terms: BPH, Lower Urinary Tract Symptoms (LUTS), Prostatitis, Prostate Cancer)