The Minimally Invasive Surgical
Therapies (MIST) Consortium for Benign Prostatic
Hyperplasia (BPH) has launched a new study to compare long-
term benefits and risks of transurethral needle ablation
(TUNA) and transurethral microwave thermotherapy (TUMT) to
a regimen of the alpha-1 inhibitor alfuzosin and the 5-
alpha reductase inhibitor finasteride.
The National
Institute of Diabetes and Digestive and Kidney Diseases at
NIH, part of the Department of Health and Human Services,
is investing more than $15 million in the study.
TUNA and TUMT use heat to destroy part of the enlarged
prostate to improve urine flow and symptoms. Early studies
suggest that these procedures reduce the occurrence of
erection or bladder control side effects, which occur more
often with the traditional surgery for BPH, known as
transurethral resection of the prostate (TURP). TUNA and
TUMT are said to be minimally invasive in part because they
typically are done with local anesthesia and men go home
the same day, whereas TURP requires general anesthesia and
an overnight hospital stay. As for drug therapy, a recently
published large randomized study showed that a regimen of
finasteride (Proscar) and the alpha-1 inhibitor doxazosin
(Cardura) prevents progression of BPH in a significant
percentage of symptomatic men and it helps men at high risk
avoid surgery.
“It’s easy to see why drug therapy, TUNA and TUMT have been
embraced by many urologists and patients,” said Leroy M.
Nyberg Jr., Ph.D., M.D., director of NIDDK’s urology
trials. “Yet, we don’t know which treatment is more
effective in the long run and, for the most part, who would
be better served by the drug combination versus one of the
minimally invasive therapies.”