Larger prostate glands improve faster after thermal therapy

Patients with benign prostatic hyperplasia undergoing convective water vapor thermal therapy (CWVTT) enjoy significant improvements in lower urinary tract symptoms (LUTS) across the prostate volume (PV) spectrum. Notably, medium and large glands appear to show faster improvement than small ones. 

A total of 171 patients undergoing CWVTT at a tertiary care centre were included in this study and divided into small (n=56), medium (n=54), and large (n=61) PV tertiles. 

The primary outcome was change in International Prostate Symptom Score (IPSS) pre- vs post-CWVTT between PV tertiles: small (≤38.5 cc), medium (38.5 to ≤55.6 cc), and large (>55.6 cc). Time to a minimally clinically important difference of 25-percent decrease in IPSS was the secondary outcome. 

Significant changes in IPSS were noted at 3 months for all PV tertiles, with mean differences of –7.51, –10.12, and –11.72 for small, medium, and large PVs, respectively (p<0.001). 

Multivariate analysis revealed that having diabetes could result in a higher IPSS after 3 months with an average increase of 3.67 (95 percent confidence interval [CI], 0.23–7.11; p=0.037) compared with not having diabetes. 

The median time (Q1, Q3) to –25 percent in IPSS was 16.1 months for small, 12.3 months for medium, and 13.8 months for large PVs. Multivariate analysis revealed that medium PV had a significantly higher incidence of a 25-percent decrease than small PV (hazard ratio, 2.10, 95 percent CI, 1.19–3.72; p=0.011). 

“All PVs experience the same improvement in LUTS post-CWVTT,” the authors said. “However, medium and large glands may improve more quickly than small glands.”