Treatments for an Enlarged Prostate

Dr. Edward J. Mueller: The GreenLight Photoselective Vaporization of the Prostate is the newest laser treatment out there that can provide relief of symptoms very comparable to a TURP, with minimal side-effects and minimal hospitalization. Dr. Barry Stein: I would say, it's like taking a hot knife through butter and the prostate just really, literally melts in front on you. Because it's done under fluid medium, we don't really see smoke per se, what it looks like is tissues just melting in front of you. And that's used to, if you will melt the tissue away, without bleeding and some of the other issues that we see, when you do a TURP procedure. Dr. Edward J. Mueller: We use a 532 nanometer wavelength laser to actually vaporize the tissue and create a wide open prostate just like with a TURP, but without any other side-effects you get with a TURP, because the high heat from the laser actually coagulates the little vessels, you get very little bleeding with it and you end up with a wide open prostatic fossa. Dr. Barry Stein: We know from many studies in the past that the prostate grows at about 4%-5% per year, and if you are not doing a surgical procedure that removes tissue, now the prostate may still continue to grow but it's going to be smaller when we are done and it's going to take a while to get back to where we were. But if you do something that doesn't remove tissue, the next year it's 4% or 5% bigger than it was the year you did your procedure and I would say that you have to apply the theory of compound interest, when you look at that. So, it's not just 4%-5% but it's 4%-5% on the extra 4%-5% and this goes on every single year of a man's life. So, the prostate after a Microwave or TUNA is getting bigger every year immediately, whereas with a laser, a GreenLight Laser or a TURP, we have really set the scale back, because we've let's say, halved the size of the prostate or possibly more. And now, it will take a good number of years till we even get back to where we were, let alone, get to be bigger than where we were. So, the failure rates run a couple of percent per year, and the other procedures, you can say that after and you can argue about the exact number, but after 4 or 5 years, something between 25%-50% of men have failed with TUNA or Microwave. But now you take GreenLight Laser or a TURP and after 4 or 5 years something like 5%-10% have failed. They need something more to be done or repeat treatment. So, there is a big difference between 25%-50% recurrence rates and 5%-10% recurrence rates. Dr. Edward J. Mueller: The three main side-effects that you see are hematuria. You may see a little blood right at the beginning of the stream for a few days afterwards. An urgency and frequency of urination, because you have got a raw surface in their and urine is usually a little acidic, this raw surface has this necrotic realm of 2 mm around it and you are urine can irritate it, which can give you the sensation like you have to urinate. And so, until that really heals over, some patients have a lot of urgency and frequency, but it's transient, it will go away. Dr. Barry Stein: Because we are not creating any bleeding, the patient has no chance of needing a transfusion. It can be done in patient who are on blood thinners, I have to do one next week, we can't stop them. You would never do that with a typical TURP. It's outpatient, patients all go home the same day and somewhat over half of them go home without even catheter. So, it's really much easier in that way, because there is no bleeding, they get back to work and normal activities quicker. So, that's what helps to make it a quicker recovery, is the lack bleeding issues. Dr. Edward J. Mueller: It's tremendously better. PVP, what I tell my patients is, take it easy for 48 hours and as long as you don't have any bleeding, you always get a little oozing after the procedure, it's like if you scrape your knee, it's what I always tell my patients. It's like you scrape your knee, you clean it, wash it, stop bleeding, put a Band-Aid on it. Next morning when you take the Band-Aid off it's pink, because you get oozing from the capillaries, where we get this big raw surface in there, and you will get a little oozing from that. And so, the patient may urinate and the beginning the stream may look a little pink, but it's not going to be bloody. And within a few days, that stops. Once that stops the patient can do pretty much anything he wants. And with a TURP, usually patients are told, they have got to limit their activity for 4-6 weeks because any straining will cause bleeding. Bleeding can cause clots and then you can't urinate and you end up back in the emergency room, getting a catheter put in and you are getting out the clots. So, the quality of life after a PVP is much better, you return to the normal quality of life quicker, and your symptom relief should be very comparable to the TURP. Dr. Barry Stein: One of the big things people really like is the outpatient aspect of it. People don't especially older people don't like to be in the hospital, so the minute you talk about surgical options, Well, I don't want to go to the hospital. But then the minute you say, But we can do this as an outpatient and you won't staying, and there is a good chance, you won't even get a catheter and we can get you back to whatever it is, golf or around here, golf or boating and whatever, they are really happier about that. Dr. Edward J. Mueller: It's open. You have a wide open channel there. Patient will urinate much better immediately, but will continue to improve because when you are done there is this wide open channel and then beyond that there is 1mm - 2mm rim of tissue that is necrotic, just like that big ball of necrotic tissue, that the Microwave, the TUMTs and the VLAP tried to create. You get this little rim around it and that will slough and die and pass over time and then the lining of prostate regrows and so your symptoms will actually improve even more as it heals. Dr. Barry Stein: That might let him go back to work with one week after the laser treatment, maybe two to three after the standard TURP, but if it's somebody with any kind of physical job with the laser, I might let him go back to work in three weeks, but I might keep him out for a couple of months if he had the regular type of thing done. And it's all about bleeding. Dr. Edward J. Mueller: I tell patients within 48 hours usually they can be back to fairly normal activity, if they have a little oozing or bleeding due to strenuous activity, just I tell them to hold off a few more days and you know it will stop. The healing is much quicker, although to get full healing with regrowth of the epithelium takes about 4-6 weeks, just like the other procedures or just like a TURP, but you don't have to wait till that point till you can get back to full normal activity. That's the key point. Dr. Barry Stein: If you look at the improvement by objective measurements that we used an subjective measurements that we used in that study, which in our business are called symptom score sheet, which is a somewhat subjective rendition of how the patient feels about the voiding pattern. And the urinary flow rate, which is somewhat objective measurement of the force of the patient's urinary strain. We bug a party chair, if you will. When you look at both of those, the improvement in both of them after this treatment was very much identical to what you would have gotten with the typical TURP treatment. Dr. Edward J. Mueller: There are multiple studies out there looking at the PVP procedure versus the TUNAs, the Microwaves and there is, the important ones I think, are the ones that are compared to the TURP or the TURP procedure, because the results of those show that you get improvement in your voiding symptoms equivalent to or even in some cases a little bit better than TURP, with much fewer side-effects. And that's been documented and these are peer reviewed studies that show that. So, I think when you are talking to patients, it's important to let them know that a lot of people are still performing the TURP and they get very good results with it. But this procedure will give you results equal to very comparable to or even a slightly better than a TURP, but you will be back. If you guys are retired, we can do it on a Thursday and Saturday morning he is back out there, playing golf and the sports, you don't have to worry about bleeding, without a catheter. With a TURP you may still be in a hospital or the catheter and those are very, very important, the quality of life aspects of the PVP procedure. Dr. Barry Stein: From the third-party payer side, it's cheaper, for all the reasons I just gave, because they are outpatient. Then it's much cheaper for them. So, there is actually nobody loosing in this trade-off, the patient is happier and third-party payer is happier. Dr. Edward J. Mueller: Last year, for the first time, there were more PVP procedures and TURPs done in this country. So, the trend is up, up, up. More and more people are seeing the benefits of it and are getting trained in doing it. Dr. Barry Stein: The GreenLight Laser is the most valid option to the TURP, and if someone isn't offering both options then they might want to check out places where they could hear about both.