How does Prostiva RF Therapy Work?
This therapy uses radio-frequency energy to create temperatures within the central portion of the prostate that reach 115 degrees centigrade or 239 degrees Fahrenheit. This results in symptom improvement for two reasons:
1) There is death of prostate tissue, termed thermal coagulation necrosis, that, over a short period of time, results in shrinkage of obstructive tissue and reduced compression upon the urethra. 2) Nerves, alpha nerves, specifically, within the prostate result in increased tone or "tightness" of the prostate. These alpha nerves are blocked by a class of drugs, called alpha blockers (Flomax, Uroxatral, Terazosin (Hytrin), Doxazosin (Cardura)). The high prostate temperatures generated by Prostiva RF therapy damage these alpha nerves, resulting in a "looser" prostate, easing urination and replacing the need for these drugs in most cases.
Who is a good candidate for Prostiva RF therapy?
Men, usually over the age of 50 years, with urinary symptoms due to prostate enlargement, are candidates for this treatment. The best results are in men with prostate volumes between 20 cc and 60 cc or grams. It is a reasonable choice for symptomatic men who have not taken medications for BPH and those who use medication presently. Many men on BPH medication have decided that a simple office based procedure is preferable to taking medication for the rest of their lives. For some it is medication side effects, and for others it is medication costs. Either way, most men who have Prostiva RF therapy no longer need to take BPH medications. Men with cardiac pacemakers, those with a history of treated prostate cancer, and prior prostate surgery, are not candidates for Prostiva RF therapy.
How does Prostiva RF therapy compare to BPH medication?
When using AUA symptom scores and peak urinary flow rates, both objective and quantifiable measures, Prostiva RF therapy was superior to Proscar, Avodart, Flomax, Uroxatral, Hytrin, and Cardura. Urinary flow rates after Prostiva improved more than twice as much as with most medications. Similarly, AUA symptom scores improved by fourteen (14) points after Prostiva RF therapy, compared to an average of six (6) points with these six different medications.
How does Prostiva RF therapy compare to standard surgery (TURP)?
In a multi-center study published in June 2004, in the Journal of Urology, five year results of 121 men with BPH, 65 treated with Prostiva RF therapy, and 56 treated with standard TURP surgery, were compared. For both treatments there were significant improvements in symptom scores, peak flow rates and postvoid residual (ability to completely empty the bladder) at five years after treatment. This shows that both treatments were durable and did not need to be repeated within that five year period. Though the degree of improvements was slightly higher with TURP/surgery, the side effects were lower with the Prostiva therapy. The TURP group reported 41 % retrograde ejaculation, compared to none with Prostiva. Erectile dysfunction, incontinence, and urethral stricture formation were also greater in the TURP surgery group, than with Prostiva. The TURP patients also require a spinal or a general anesthetic, as well as a hospital stay, unlike those who have the office based Prostiva RF therapy. In addition, after a standard TURP, patients have restrictions in their activity for two weeks or possibly longer, as compared to Prostiva RF therapy, after which patients can resume normal activities within a few days.
What can I expect from Prostiva therapy?
If you choose to have this treatment, you may be asked to have some testing prior. You will be prescribed oral pain killers and possibly a relaxant to take at home before the procedure. Therefore, you will need a ride to our office and home. We will do a prostate ultrasound to get measurements and to administer the local anesthetic. The Prostiva RF procedure itself usually takes about 20 minutes. After the procedure, we will observe you for about 30 minutes or until you are ready to safely go home.
Approximately 70% of patients experience improvement from Prostiva RF therapy. It may take from one to three months to reach full effect. Some patients experience worsened urinary symptoms, temporarily, such as frequency and burning, after the procedure. These symptoms usually last a few days, but can persist for a few weeks. Some patients, due to prostate swelling, have difficulty voiding after the treatment with between 10% and 20% requiring a temporary catheter for one or two days. Patients are sent home with prescriptions for an antibiotic and analgesics and given an appointment to return to our office for a follow-up visit.