Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology
Introduction & Objective : PUL has been shown to deliver rapid, significant and durable BPH symptom relief with low morbidity. To determine how baseline patient characteristics correspond with treatment outcomes, data from the largest randomized study of the PUL procedure (L.I.F.T. Study) were analyzed to determine baseline predictors of response.
Two definitions of responder were explored. The first was a patient who experienced an average International Prostate Symptom Score (IPSS) improvement ≥ 4 points from 3 months through 5 years. The second defined a responder as a patient who did not require subsequent BPH surgery or medication by 5 years. Univariate assessments of predictive value were conducted for baseline parameters including age, prostate volume, PSA, voided volume, PVR, bladder capacity, peak flow rate, BMI, quality of life and the individual IPSS elements.
PUL subjects experienced improvement from baseline by 1 month (IPSS 44%, QOL 42% p<0.0001) that was sustained to 5 years (IPSS 36%, QOL 50%, p<0.0001). Using the first responder definition, 82% of patients achieved ≥ 4 point average IPSS improvement over 5 years. For each point in the urgency and hesitancy scales, the odds increased by 43% and 49% respectively to achieve that goal. For the second definition, 76% of patients did not require BPH intervention or medication by 5 years with significant predictors found to be incomplete emptying, intermittency, weak stream, quality of life, PSA and peak flow rate (Table 1).
Patients who are still early in the disease process at baseline may have the best long-term response to PUL treatment in terms of significant IPSS improvement and avoidance of subsequent therapy by 5 years. Patients with baseline indicators of advanced disease such as low peak flow rate, high PSA, and high scores on quality of life and the IPSS voiding elements appear more likely to require surgical or medical intervention at 5 years.