The surgery, known as transurethral resection of the prostate, or TURP, is generally reserved for those who have failed to respond to drug treatment or who cannot tolerate the medications, but the new findings suggest it might be useful to introduce it earlier in the course of the disease, said Dr. Amy Krambeck of the Mayo Clinic in Rochester, Minn., who reported the findings at a San Francisco meeting of the American Urological Assn.
"This is a very interesting study" with findings that are not completely surprising, but it is not a randomized clinical trial, so it will not change practice, said Dr. Jack Jacoub, a medical oncologist at Orange Coast Memorial Medical Center in Fountain Valley. "But it does give us something to discuss with patients when deciding what form of therapy to choose."
What is important about the study is that it looks at a broad cross section of patients, not just those being treated by one group of investigators, said Dr. Hyung Lae Kim of the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center. "It gives a big picture of what is going on" in the community, he said.
More than half of men older than 50 and more than 80% of men older than 90 suffer from benign prostatic hyperplasia, or BPH. The most common symptoms include a frequent urge to urinate and persistent leakage.
Multiple treatments are available, but data comparing medications with surgery are very limited. For patients with the mildest symptoms, treatment may entail little more than reducing consumption of alcohol and caffeine.
Krambeck and her colleagues used a database linking the medical records for all people in Olmsted County, Minn. They identified 2,184 men ages 40 to 79 diagnosed with BPH between 1990 and 2007.
Of those men, 72% received no treatment, 23% took medications, 1% had a laser surgery to vaporize some prostate tissue, and 4% underwent TURP. Symptoms were assessed through regular questionnaires.
Among those who received treatment, "the best improvement in symptoms, by far, was seen in the TURP group, followed by laser vaporization, then the drugs.... Only the surgical intervention group reported a decrease in incontinence," from 64.5% to 41.9%, Krambeck said. Regardless of whether medication or surgery was used, "the symptoms appeared to stabilize — they didn't seem to be getting worse."
Counterbalancing the effectiveness of the surgery, however, are the potential side effects, including bleeding, low sodium in the blood, incontinence and erectile dysfunction.
If this study had been blinded and randomized, Jacoub said, it might have led to a paradigm shift in treatment. "But right now, the jury remains out."