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TransUrethral Microwave ThermoTherapy (TUMT) for Prostate

Minimally-Invasive Treatment for BPH Gaining Widespread Acceptance


Leonard S. Marks, M.D.

Medical Director, USRF

FALL, 2004---A heat treatment to shrink the prostate, performed under local anesthesia in the doctor’s office, appears to be gaining widespread acceptance. Known as TransUrethral Microwave Thermotherapy (TUMT), the treatment was introduced in Europe some 20 years ago. Now because of advances in technology, making TUMT a relatively simple, safe procedure, physicians are increasingly using TUMT as definitive treatment for men with BPH obstruction in outpatient settings across the U.S. FDA approval and Medicare’s inclusion of the procedure as a “covered benefit” have also furthered the extensive adoption of TUMT, expected to reach tens of thousands of men this year.

Efficacy of TUMT was recently demonstrated in a large clinical trial, published this year in Urology. In a study of 541 men treated in England, Canada, and 6 University hospitals in the U.S., symptoms were reduced by an average of 55% and urinary flow was increased by 51% after TUMT. Moreover, the benefit appeared to persist for at least 4 years, which was the length of follow-up in this study, in the great majority of men. PSA was not affected by TUMT. While adverse events were not reported in this paper, it is generally believed that the procedure has little, if any effect on erectile function, ejaculation, or urinary continence. According to the BPH Guidelines of the American Urological Association (2003), “…transurethral microwave heat treatment is more effective than medical therapy but less effective than surgery in relieving symptoms.”

Data on four different TUMT devices were evaluated for the current AUA Guidelines: Prostatron® and Targis®, water-cooled, high energy devices from Urologix, the DOT® device from TherMatrx, utilizing low energy, non-cooled, and CoreTherm®, an ACMI product, utilizing high energy with limited cooling . OUTCOMES for symptoms, flow rate, durability of response, re-treatment rates, and erectile dysfunction show essentially no differences between treatments (including TUNA); thus, most of the following remarks pertain to the Prostatron device, which has been studied the most intensively and is a direct descendent of the device introduced by the EDAP company in France some 15 years ago. An early report on the Prostatron was posted to the USRF website in 1998.

TUMT works by heating the prostatic adenoma via microwave energy. In brief, microwaves emitted from the urethral antenna are aimed at the prostate lateral lobes. Within the tissues of the prostate, microwaves induce oscillations of the water molecules, resulting in the release of kinetic energy which generates heat. Prostatic tissue undergoes coagulation necrosis when exposed to temperatures greater than 45 degrees C for 30 minutes or more. Patient discomfort is minimized by cooling the heat-sensitive urethra via water circulating in the outer part of the catheter. A rectal temperature monitor prevents over-heating of adjacent tissues. A detailed description of the physics of TUMT is given in this Urologix white paper.

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