Treatment characteristics and inherent prostatic features do not predict patient outcome after high-energy transurethral thermotherapy: a prospective study of prostalund feedback treatment.
OBJECTIVE
To determine whether treatment characteristics, intrinsic prostatic factors, and clinical parameters predict the outcome in patients treated with high-energy transurethral microwave thermotherapy (HE-TUMT).


METHODS
A series of 48 consecutive patients, 28 with an indwelling catheter, underwent ProstaLund Feedback Treatment (PLFT). The 12-month International Prostate Symptom Score response rate (IPSS < or = 7 or > or =50% improvement), peak flow rate response rate (Q(max) > or = 15 mL/sec or > or =50% improvement), and bladder outflow obstruction index response rate (BOOI <40) were correlated with treatment characteristics such as duration, average intraprostatic temperature, time with therapeutic intraprostatic temperatures (>45 degrees C), average intraprostatic blood flow, consumed energy, and recorded prostate mass destruction. Baseline parameters such as age, serum prostate specific antigen concentration, prostate volume, and pretreatment IPSS, quality of life (QOL), Q(max), postvoiding residual urine volume (PVR), and BOOI were included in the logistic regression analysis.


RESULTS
Treatment characteristics did not discriminate responders and nonresponders to HE-TUMT. For the patients without a catheter, the IPSS response (75%) was predicted by higher pretreatment IPSS (P = 0.041; relative risk [RR] = 3.4) and higher pretreatment PVR (P = 0.026; RR = 1.1). The Q(max) response (85%) was predicted by higher grades of pretreatment obstruction (P = 0.009; RR = 1.02). The BOOI response (60%) was not related to any of the factors tested. For the patients with a catheter, no outcome predictors could be identified.


CONCLUSIONS
According to our results, the intraprostatic temperature, the duration of intraprostatic temperatures in the therapeutic range, and the pattern of blood flow did not predict HE-TUMT outcome. Treatment duration, consumed energy, and the magnitude of tissue necrosis did not translate into clinical efficacy. Clinical parameters were important predictors of outcome in patients not in retention.
Ferakis
N
N
2nd Department of Urology, School of Medicine, University of Athens, Sismanoglio General Hospital, Athens, Greece.
Skolarikos
A
A
Staios
D
D
Liakouras
C
C
Alivizatos
G
G
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011469:Prostatic Diseases / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome