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Letters for Tuesday, May 29, 2001
Letters for Tuesday, May 29, 2001

Prostatron Thermotherapy sounds like something you'd find in Buck Rogers' spaceship.

America's first space hero, whose adventures were launched in a 1929 comic strip, Buck would be over 70 years old today. He could be among the 50 percent of men over 60 years old who suffer from benign prostatic hyperplasia (BPH), or non-cancerous enlarged prostate. And he could be among the one in four of those men who need some type of treatment for the condition.

If he did have BPH, Buck might be able to take advantage of Prostatron Thermotherapy, a new treatment available in Montana for the first time this year.

Dr. Anthony Doerr of Missoula has been offering the procedure at Community Medical Center for about four weeks, with "pretty successful results," he said.

BPH differs from prostate cancer, which attacks the periphery of the gland, while BPH affects the center, through which the urinary channel passes, Doerr said.

Typical lower urinary tract symptoms of BPH include frequency, urgency or hesitancy in urination, slowness of stream, having to get up in the middle of the night to urinate, and a feeling of not being able to empty the bladder.

Also known as transurethral microwave therapy (TUMT), Prostatron Thermotherapy is a nonsurgical alternative to treat BPH that is less expensive and has fewer long-term side effects than other treatments, according to Doerr. The treatment is a one-time outpatient procedure that takes only 30 minutes.

Previous treatments available for BPH vary widely.

For men with mild symptoms, Doerr said, the preferred treatment could be "watchful waiting" to see if the symptoms worsen.

If symptoms are affecting quality of life, he said, one of the first treatment options could be alpha-blocker medication, which relaxes the muscle around the prostate to improve symptoms.

The alpha blockers work well, according to Doerr. But they have some side effects, including nasal congestion and light-headedness. Some men can't tolerate the medication, he said.

For men with very large prostates, another type of medication treatment may be required, said Doerr. But it can have sexual side effects, including loss of libido and erectile dysfunction. Another drawback is that it takes longer to determine if it is effective.

If symptoms are serious or persistent, Doerr said, a surgical therapy, transurethral resection of the prostate (TURP), is available. The surgery is commonly known outside the medical profession as the "Roto-Rooter procedure," he said.

"TURP is very successful in relieving symptoms and quality of life," Doerr said, but it, too, has drawbacks.

The surgery usually requires a general anesthetic, while a physician "scoops out the urethral channel tissue" through a catheter, said Doerr. And it usually requires a two-day hospital stay after the operation.

Side effects of TURP include bleeding, sometimes requiring a blood transfusion, and incontinence and/or impotence in a very small percentage of patients.

In addition, Doerr said, about 50 percent of patients experience "retrograde ejaculation" as a side effect of TURP, in which an ejaculation goes back into the bladder. The malady does not affect sexual potency or sensation, only fertility, which generally is not a factor because of the patient's age, he said.

The surgery also can cause scarring that can restrict the urethral channel, Doerr said.

Another surgical treatment, for men with a very large prostate, involves opening the abdomen with an incision, and then cutting out the center of the prostate.

That surgery necessitates a longer recovery time, he said.

Because of the complications and side effects of surgery, microwave therapy was developed as an alternative treatment in the early 1980s, Doerr said. It used heat to create a cavity around the urethra, just as the surgical procedure does.

Initially, the microwave treatment used relatively low energy, took about an hour to complete, and wasn't very effective. Later variations used higher energy, and were more effective, but the heat also caused tissue damage to the urethra, resulting in other complications.

The new Prostatron Thermotherapy equipment, which has been in use in the United States for about two years, delivers high energy to the prostate through a microwave probe at the end of a catheter. Guided by ultrasound scanning, the probe is precisely positioned by computer, Doerr said.

The technology reduces treatment time to only 30 minutes, and incorporates a cooling device that prevents damage to the urethra. The improved procedure reduces patients' need for a catheter afterward, and diminishes discomfort during treatment as well, according to Doerr.

This new therapy is an outpatient procedure, he said, and does not require a general or spinal anesthetic. Usually, he uses either no anesthetic or a local sedation, Doerr said.

As soon as patients urinate following the procedure, they are able to go home. And only about one in 10 patients requires use of a catheter for a week to 10 days after the procedure.

The major downside of Prostatron Thermotherapy, said Doerr, is that a patient's symptoms may get worse before they get better. Because of inflammation of the tissues, he said, it may be some time before swelling subsides and a patient's symptoms improve.

"Typically," he said, "it's within several weeks. But sometimes it takes several months for maximum benefit or complete improvement. So, if after one month they're not quite where they want to be, I let them know there's a chance for improvement out to several months."

Physicians use two methods to measure BPH symptoms before treatment, and track the progress of patients afterward, Doerr said.

One method uses a score sheet in which patients rank their symptoms from 1 to 5 - better to worse. Another method measures urine flow rate.

The TURP surgical procedure tends to produce a superior flow rate, according to Doerr. However, when patients rank their symptoms on the score sheet, Prostatron Thermotherapy and TURP show equivalent results.

In a cost comparison with medication treatments and TURP, Doerr said, Protatron Thermotherapy is quite attractive.

Alpha blocker pills cost in the neighborhood of $900 a year. Over a man's lifetime, say from 60 to 80 years old, the cost would be about $18,000.

The TURP surgical procedure costs average about $6,600 and ranges up to $10,000.

Prostatron Thermotherapy costs $2,900. The procedure is covered by Medicare and most major Montana insurance providers.

Some men are not candidates for Prostatron Thermotherapy.

The procedure is not effective for men with an enlarged prostate that protrudes into the bladder, Doerr said. But that's a fairly rare condition.

Also, he said, patients with pacemakers or implanted heart defibrillators must consult with their cardiologist about the procedure because the microwave treatment can interfere with the devices.

In addition, the treatment can cause complications for men who have had pelvic radiation treatment in the past.

Men who have artificial hips are sometimes excluded as candidates, Doerr said, although many have been treated successfully.

On the other hand, he added, men with significant medical problems often are excellent candidates for Prostatron Thermotherapy. It's especially appropriate for men who are unable to have general anesthetic for some reason.

"For instance," Doerr said, "one patient with emphysema couldn't have a general anesthetic. So he couldn't be treated by TURP. He had a catheter for two years. Now, after the Prostatron treatment, he's catheter free."

The federal Food and Drug Administration, which approved Prostatron Thermotherapy in 1996, has reported rare complications of erectile dysfunction resulting from improper use of the equipment, Doerr said.

"As long as you monitor the computer to make sure the catheter is still in the right place," he said, "and follow the guidelines, I think those kinds of complications are going to be extremely rare."

The equipment used at Missoula's Community Medical Center for the treatment is mobile. It's been shared by hospitals throughout the state for the past three months. It visits Community Hospital once a month.

Currently, said Doerr, the treatment is performed in the Community Hospital operating room. But eventually it will be completed in the physician's office.

So far, Doerr said, he's treated about 15 patients with the new technology.

"Initial results are good," he said. "But we don't know how good it is yet. After six months is when we should see maximum results. But the patients so far have been very happy with the treatment."

Melvin Sharbano of Missoula is one of those.

Sharbano, who is 74, was one of the first patients to have the Prostatron Thermotherapy treatment from Doerr.

Before the procedure, Sharbano said, he had difficulty urinating, and had to get up four or five times a night to go to the bathroom.

The results, he said, are "great."

Doerr told him it would take about six months before he experienced the full benefit of the treatment, Sharbano said.

"But I'm good now," he said. "I think there are a lot of men who haven't heard about it. It's a wonderful thing."

Reporter Daryl Gadbow can be reached at 523-5264 or at dgadbow@missoulian.com.

If you're interested

For more information about Prostatron Thermotheraphy, call the Rocky Mountain Prostate Center in Colorado at 1-800-619-9691; or visit its Website at www.rmpc.net; or call Dr. Anthony Doerr at Community Medical Center at 543-1967.

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