Blast of water could shrink an enlarged prostate as effectively as surgery – and with fewer side-effects
A blast of water could shrink an enlarged prostate as effectively as surgery, but with fewer side-effects, a new trial suggests.
The probe-like device, which fires a high-speed jet of salt water at the gland to remove excess tissue, works in minutes and has a four-fold lower risk of sexual complications, compared with surgery, say researchers from Frimley Park Hospital in Surrey and other centres.
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate, a walnut-sized gland below the bladder. Its main job is to make fluid for semen.
The cause of the condition — which affects around half of men in their 50s and up to 90 per cent of those over 80 — is not fully understood, though one theory is that, as men age, their testosterone levels drop, triggering the growth of prostate cells.
Progress: The AquaBeam water jet system fires a saline solution at the prostate from a tube-like device that is fed through the urethra and into the bladder, guided by ultrasound images
Not all affected men will have symptoms. However, an enlarged prostate can compress the urethra, the tube that carries urine from the body, causing frequent trips to the loo, a weak urine stream and a feeling of not fully emptying the bladder.
Mild symptoms are usually treated with medicines such as alpha blockers, which relax the muscle of the prostate and bladder neck, allowing urine to flow more easily.
If medication doesn’t work, then surgery is an option — transurethral resection of the prostate (TURP), which removes excess tissue, is considered the gold standard, but is invasive and can lead to erectile dysfunction or incontinence.
To try to avoid these side-effects, techniques less likely to damage healthy tissue are being investigated. The AquaBeam water jet system fires a saline solution at the prostate from a tube-like device that is fed through the urethra and into the bladder, guided by ultrasound images.
Destroyed tissue is suctioned out and removed via holes in the device. The procedure is usually carried out without a general or spinal anaesthetic.
A trial on around 200 patients comparing the procedure with TURP, reported in the journal Advances In Therapy, found it was highly effective.
Did you know? Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate, a walnut-sized gland below the bladder
Two years after the treatment, nine out of ten men in both groups had a significant improvement in their symptoms.
However, those who’d received the water jet had better urine flow: this increased from below 5ml per second to about 11ml per second in this group, compared with an improvement to 9ml per second in the TURP group.
There were also fewer sexual side-effects in the water jet group. Among sexually active men, anejaculation (an inability to ejaculate semen) was less common in the water jet group — 10 per cent, compared with 36 per cent in the surgery group.
Professor Raj Persad, a consultant urologist at Bristol Urology Associates, says: ‘TURP is fraught with potential complications.
‘But minimally invasive procedures such as this can often be done as a day case and even under local anaesthetic.’
WHAT IS PROSTATE CANCER?
How many people does it kill?
Prostate cancer became a bigger killer than breast cancer for the first time, official statistics revealed last year.
More than 11,800 men a year – or one every 45 minutes – are now killed by the disease in Britain, compared with about 11,400 women dying of breast cancer.
It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain. In the US, the disease kills 26,000 each year.
Despite this, it receives less than half the research funding of breast cancer – while treatments for the disease are trailing at least a decade behind.
How quickly does it develop?
Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS.
If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted.
Some patients can be cured if the disease is treated in the early stages.
But if it diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.
Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.
Tests and treatment
Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge.
There is no national prostate screening programme as for years the tests have been too inaccurate.
Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.
Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.
But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not foolproof.
Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks.
Anyone with any concerns can speak to Prostate Cancer UK’s specialist nurses on 0800 074 8383 or visit prostatecanceruk.org
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