Patients with large prostates (LP), defined as greater than 80 grams, are generally limited to certain procedures such as a prostatectomy or transurethral resection of the prostate (TURP) when surgery is required. In most instances, these procedures require general anesthesia and admission. In more recent years, however, investigators are introducing alternative therapies to men with LP with less invasive options for treatment.
In a study presented at the 2021 American Urological Association Annual Meeting, Michael Palese, MD, Evan Garden and co-authors estimate the long-term outcomes of Rezum water vapor therapy in treating men with LP (greater than or equal to 80 grams) who have benign prostatic hyperplasia (BPH). Dr. Palese is the Chair of the Department of Urology at Mount Sinai Downtown & Beth Israel Medical Center and Evan Garden is a fourth-year medical student at the Icahn School of Medicine at Mount Sinai, New York, New York.
Palese: The reason that we started looking at using this procedure, called Rezum or water vapor treatment, for this particular population of men was that there aren't many options for men with very large gland prostates. So, in men with prostates that are 80 grams or larger, you really either need to do a TURP - and again there's only so large of a TURP that you can do - or you're looking at doing a prostatectomy. The traditional approach for prostatectomy would be an open approach where you make an incision to remove the prostate. Nowadays, we're doing these robotically and laparoscopically. But again, this still requires general anesthesia. There is also a potential for higher complications. Patients need to remain in the hospital at least 1 night, if not 2 nights, so we were looking for an alternative for avoiding general anesthesia and more invasive surgery.
The Rezum became very interesting to us because it had the potential to do that. We had some excellent success with our initial patients, who have prostates between 20 and 80 grams. We started to look at this with an IRB approved study to see if we could do this in men with larger glands and hopefully push the envelope a little bit. We presented our data at the American Urologic Association meeting this year. We have also published our preliminary data.2 We have had some interesting findings that I think are very promising. We'd love to see if others can recreate it and see if they have the same, or hopefully better, outcomes than we did. That's the main reason why we chose to look at this as an alternative treatment for large gland prostates.
Garden: We divided our outcomes into a number of different categories: whether they were functional outcomes related to patients' urinary function, proxies for the severity of disease, self-reported symptom scores, reliance on medications, and the safety profile of the procedure for this subset of patients with prostates greater than 80 grams. We also compared the rates of certain post-procedural complications to patients whove had prostates less than 80 grams. Regarding functional outcomes and disease-related outcomes, we found that both groups of men, with greater than and less than 80 grams-sized prostates, had significant improvements in urinary function as demonstrated by Uroflow and post void residual. We also found that they had improvements in AUA symptom score, and we found that both groups had significantly decreased reliance on alpha blockers, which is one of the primary categories of medications used to provide symptomatic relief for patients with BPH. These are medications like tamsulosin, silodosin, etc.
And then in terms of the clinical side effects of the procedure, we found that largely the clinical side effect profile demonstrated by the 2 groups were comparable. No statistically significant differences in rates of urinary tract infection, hematuria retention, emergency room visits or post-operative hospitalizations. The only difference was that men with larger prostates reported significantly increased rates of post-operative urgency compared to men with smaller prostates.
The other significant finding that we found was those men with large prostates greater than 80 grams were surgically retreated at a significantly higher rate. So, the retreatment rate for our small prostate cohort was 4.4%, which is in line with the results demonstrated from the original WATER clinical trial,3 which also had a retreatment rate of 4.4%. For our large prostate cohort, this subset of patients had a retreatment rate of 18.4%, so a little less than one in five patients required subsequent procedural intervention for BPH related symptoms.
Palese: The significant finding is that we are dealing with a larger gland, which means more tissue needs to be ablated. It is therefore not surprising that we would have found it to be a much higher retreatment rate than with smaller glands. But a 1 in 5 retreatment rate is clinically not terrible. It does give men another option, and so I think that's really what we're focusing on here. Giving the option to avoid general anesthesia and to avoid a more invasive surgery, with the intent that if we don't have success that we're looking for, we still can go back and do one of the more traditional approaches.
Palese: One of the most important things about this procedure is setting up patient expectations. When patients come to see us, we want to provide the information that they require to make an informed decision and informed consent about what they're doing, and that their expectations are in line with what they're seeking. For the Rezum, one of the reasons that a lot of men will seek it out is because it tends to have minimal sexual side effects compared to many of the other procedures available. A lot of my younger patients will request to do a Rezum procedure, knowing that they'll probably need some type of retreatment or some other type of treatment in the future, anywhere from 3 to 5 years. We keep that in mind when we're recommending treatments, like Rezum. We want to make sure that patients understand what they're signing up for, what their expectations are and what they hope they can achieve by doing this procedure.
Palese: The main goal here is to provide another alternative for the large gland prostate group. It's certainly not something that I believe a urologist who's just starting out doing Rezum should be undertaking. I think you do need to get some experience with the traditional 20-to-80-gram group. There's no question that there is a learning curve. It important to understand how to counsel the patients as well because they do have more irritative symptoms afterwards. There's more inflammation and they tend to keep the catheter a little bit longer than with the other smaller gland prostates. I think these are all things that need to be addressed with a patient upfront, and they need to understand that there are going to be some differences. The main take-home message here for the urologist is that this is another alternative. It doesn't always work with an 18% retreatment rate but it is another option.
Garden: It's always important to understand the context in which this research is done. There are some limitations to our findings. This was a retrospective, not a prospective, study. So, while this study does offer a lot of promise for the treatment options that we can offer to these patients, it does also highlight the need for further prospective trials to evaluate the efficacy of this treatment for this population, as well as the efficacy of all the different surgical options available to patients who are suffering from BPH. We hope that this can contribute to the existing body of literature to better inform urologists and patients alike.
References
1. Garden E, Ravivarapu K, Levy M, et al. Rezum for men with large prostates 80 cc versus small prostates <80 cc: Updates outcomes and long-term results. Paper presented at: 2021 American Urological Association Annual Meeting; September 10-13, 2021; virtual. Abstract MP09-05
2. Garden EB, Shukla D, Ravivarapu KT, et al. Rezum therapy for patients with large prostates (80 g): Initial clinical experience and postoperative outcomes. Published online January 3, 2021. World J Urol. doi:10.1007/s00345-020-03548-7
3. McVary K, Roehrborn C. Five year results of the prospective, randomized controlled trial of water vapor thermal therapy for treatment of lower urinary tracts symptoms due to benign prostatic hyperplasa. Published online April 1, 2020. J Urol. doi:10.1097/JU.0000000000000946.06
Read the rest here:
Long-term results of Rezum therapy for patients with large prostates - Urology Times
- Ed's Guide to Alternative Therapies - pathguy.com - December 8th, 2016 [December 8th, 2016]
- Complementary and Alternative Medicine Guide | University ... - December 8th, 2016 [December 8th, 2016]
- Complementary and Alternative Medicine (CAM) Overview - December 26th, 2016 [December 26th, 2016]
- Alternative Medicine, Holistic Doctors,Naturopathic ... - January 5th, 2017 [January 5th, 2017]
- Alternative Medicine Degrees - Excite Education - January 13th, 2017 [January 13th, 2017]
- Alternative Medicine | Category | Fox News - January 13th, 2017 [January 13th, 2017]
- Alternative Medicine - Disabled World - January 13th, 2017 [January 13th, 2017]
- Alternative Medicine Degree, BS - Everglades University - January 23rd, 2017 [January 23rd, 2017]
- Alternative Medicine | Duke University Press - January 23rd, 2017 [January 23rd, 2017]
- Bill to rein in alternative medicine practitioners - Bangalore Mirror - February 8th, 2017 [February 8th, 2017]
- Peroxide ingestion, promoted by alternative medicine, can be deadly - Science Daily - February 8th, 2017 [February 8th, 2017]
- Can Peroxide Kill You? Yes, Say Doctors About This Alternative Medicine Favorite - Medical Daily - February 8th, 2017 [February 8th, 2017]
- Marijuana tension between clinical, alternative medicine ... - Washington Times - February 9th, 2017 [February 9th, 2017]
- Cannabis providers feel tension between clinical and alternative medicine - The Cannabist - February 11th, 2017 [February 11th, 2017]
- Happy Healthy YOU - Tillsonburg News - February 15th, 2017 [February 15th, 2017]
- Health dept cracks down on alternative meds containing sildenafil citrate - NYOOOZ - February 18th, 2017 [February 18th, 2017]
- Alternative Medicine Conferences | Traditional Medicine ... - February 24th, 2017 [February 24th, 2017]
- American Institute of Alternative Medicine - February 24th, 2017 [February 24th, 2017]
- Alternative medicine to treat pain and other ailments on the rise locally - Rockford Register Star - February 25th, 2017 [February 25th, 2017]
- Alternative Medicine Career Information and Education ... - February 27th, 2017 [February 27th, 2017]
- Why is alternative medicine so popular? - Alternative ... - February 27th, 2017 [February 27th, 2017]
- Potential dangers and dubious history of alternative medicine are often unknown to its consumers - MinnPost - February 28th, 2017 [February 28th, 2017]
- New form of alternative medicine comes to OU - Oaklandpostonline - March 1st, 2017 [March 1st, 2017]
- OPENING THE PLAYBOOK ON ALTERNATIVE MEDICINE - Dope Magazine - March 2nd, 2017 [March 2nd, 2017]
- Ask a Doctor: Is there an alternative medicine treatment for constant pain? - Chattanooga Times Free Press - March 7th, 2017 [March 7th, 2017]
- Alternative medicine grows in Sugar Land, Missouri City - Community Impact Newspaper - March 7th, 2017 [March 7th, 2017]
- Medicine with a side of mysticism: Top hospitals promote unproven therapies - STAT - March 7th, 2017 [March 7th, 2017]
- Abstracts: Obamacare Replacement, Alternative Medicine, and More - Undark Magazine - March 8th, 2017 [March 8th, 2017]
- For Prairie Village practitioner, personal experience led to interest in alternative medicine techniques - Shawnee Mission Post - March 8th, 2017 [March 8th, 2017]
- Financial Planning + Alternative Medicine - March 8, 2017 ... - KHTS Radio - March 9th, 2017 [March 9th, 2017]
- Premier U.S. Hospitals Are Selling Unproven Alternative Therapies ... - KQED - March 11th, 2017 [March 11th, 2017]
- Speakers lay stress on use of alternative medicine - The Nation - March 11th, 2017 [March 11th, 2017]
- Top U.S. hospitals promote unproven medicine with a side of ... - PBS - PBS NewsHour - March 11th, 2017 [March 11th, 2017]
- Medical cannabis expert discusses treatment options - Herald-Whig - April 8th, 2017 [April 8th, 2017]
- 5 ALTERNATIVE MEDICINES EVERY MAN SHOULD BE AWARE OF - TORO Magazine - June 6th, 2017 [June 6th, 2017]
- CID unearths fake 'council of alternative medicines' in Behala - Millennium Post - June 11th, 2017 [June 11th, 2017]
- Parents who believe in 'alternative nutrition' convicted after baby dies of malnutrition - Telegraph.co.uk - June 14th, 2017 [June 14th, 2017]
- Times of Malta Alternative medicine - Times of Malta - June 16th, 2017 [June 16th, 2017]
- Suffering from severe pain? Experts say THIS form of alternative medicine will work just as well as drugs! - Zee News - June 20th, 2017 [June 20th, 2017]
- IBAM Indian Board of Alternative Medicine - June 20th, 2017 [June 20th, 2017]
- Alternative medicine practitioner charged with sexual assault in Burlington - Hamilton Spectator - June 20th, 2017 [June 20th, 2017]
- Mind, body, spirit: Nurse opens holistic health store to promote overall wellness - Muscatine Journal - June 21st, 2017 [June 21st, 2017]
- Four of the Most Misused Terms in Alternative Medicine - ATTN: - June 24th, 2017 [June 24th, 2017]
- How cupping therapy helps athletes like Michael Phelps as an alternative medicine - Sport360 - June 26th, 2017 [June 26th, 2017]
- Calimesa Alternative Medicine - Weedmaps - June 26th, 2017 [June 26th, 2017]
- Homeopathic Health Center | Columbus, OH - (614) 890-2589 - June 26th, 2017 [June 26th, 2017]
- Alternative Medicine | What Is Alternative Medicine? - June 26th, 2017 [June 26th, 2017]
- Quotes About Alternative Medicine (30 quotes) - June 26th, 2017 [June 26th, 2017]
- Alternative Medicine That Doctors Recommend | Reader's Digest - June 26th, 2017 [June 26th, 2017]
- Alternative Medicine Schools - Excite Education - June 26th, 2017 [June 26th, 2017]
- Medical journal takes aim at natural remedies - CBC.ca - June 26th, 2017 [June 26th, 2017]
- Healing through alternative medicine: Winona locals choose acupuncture as a cure - Winona Daily News - June 26th, 2017 [June 26th, 2017]
- Patrick Noel, DC: Restoring the body's innate ability to heal through chiropractic care - Colorado Springs Gazette - June 27th, 2017 [June 27th, 2017]
- Back Pain? Try Yoga - New York Times - June 29th, 2017 [June 29th, 2017]
- Jerusalem: Alternative healer indicted on rape charges - The Jerusalem Post - June 29th, 2017 [June 29th, 2017]
- Does Pink Himalayan Salt Have Any Health Benefits? - TIME - June 29th, 2017 [June 29th, 2017]
- Not all wellness is bullshit - Quartz - June 30th, 2017 [June 30th, 2017]
- What's happening in your body during acupuncture? - The Verge - July 1st, 2017 [July 1st, 2017]
- Natural and Alternative Medicine against Asthma - Radio Cadena Agramonte - July 3rd, 2017 [July 3rd, 2017]
- Alternative Medicine in Halacha: a Review - Yeshiva World News - July 3rd, 2017 [July 3rd, 2017]
- West Bengal's top doctors turn out fakes, arrests blow lid off thriving scam - Hindustan Times - July 5th, 2017 [July 5th, 2017]
- Sudbury woman chooses alternative treatments for stage 4 cancer - CBC.ca - July 6th, 2017 [July 6th, 2017]
- Unbiased reporting can help call time on pseudoscience - EuroScientist - July 6th, 2017 [July 6th, 2017]
- Holistic therapy for pets? Traditional vet care being blended with reiki, acupuncture - Georgia Voice - July 7th, 2017 [July 7th, 2017]
- A Memoir of Chronic Fatigue Illustrates the Failures of Medical Research - The New Yorker - July 10th, 2017 [July 10th, 2017]
- Valtrex after expiration - Alternative medicine for herpes simplex 2 - Van Wert independent - July 11th, 2017 [July 11th, 2017]
- Sacred Space, University of Miami partner to educate community on wellness - Miami Herald - July 11th, 2017 [July 11th, 2017]
- One FDA About-Face Doesn't Mean an Orphan-Drug Bonanza - Bloomberg - July 12th, 2017 [July 12th, 2017]
- 'Bridging medicine with nature' - The Torrington Telegram - July 12th, 2017 [July 12th, 2017]
- Gwyneth Paltrow's Goop posted a defense of its jade eggs for vaginas. It's a mess. - Vox - July 14th, 2017 [July 14th, 2017]
- Acupuncture for pets? Yes, it's a thing - MyDaytonDailyNews - July 15th, 2017 [July 15th, 2017]
- Create Ministry for traditional, alternative medicine - Association - Graphic Online - July 17th, 2017 [July 17th, 2017]
- Native American healing class sparks unique health textbook - ABC News - July 18th, 2017 [July 18th, 2017]
- Rav Elyashiv ZTL On Alternative Medicine By R. Yair Hoffman - Yeshiva World News - July 18th, 2017 [July 18th, 2017]
- Expedite action on the passage of the alternative medicine bill ... - GhanaWeb - July 18th, 2017 [July 18th, 2017]
- Is Gwyneth Paltrow's pseudoscience winning? - Vox - July 20th, 2017 [July 20th, 2017]
- Salt Therapy Gaining Popularity in Alternative Medicine Circles - Newsmax - July 22nd, 2017 [July 22nd, 2017]
- Vargas: Weeding out herbal remedies for our pets - News Chief - July 24th, 2017 [July 24th, 2017]
- Patients recognise over-worked GPs as majority agree to see alternative medical professionals - Herald Series - July 25th, 2017 [July 25th, 2017]
- Cancer controversies and traditional medicines - Regina Leader-Post - July 26th, 2017 [July 26th, 2017]