Five-Year Outcomes of Water Vapor Therapy vs Doxazosin, Finasteride, and Combination Therapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Cohort Data From the Medical Therapy of Prostatic Symptoms Trial

Abstract

Objective To compare 5-year clinical and subjective treatment outcomes of water vapor thermal therapy to Medical Therapy of Prostatic Symptoms (MTOPS) trial cohorts receiving doxazosin, finasteride, or combination therapy. Methods MTOPS subjects who received doxazosin, finasteride, combination therapy, or placebo (ClinicalTrials.gov NCT00021814) were compared to the treatment arm of a randomized controlled trial of thermal therapy using the Rezūm System (NCT01912339). Only MTOPS subjects who met criteria for the Rezūm trial were included (prostate volume 30-80 cc, International Prostate Symptom Score [IPSS] ≥ 13). Inverse probability weighting by the propensity score was used to adjust for potential confounding variables. Subjective, objective, and clinical progression outcomes were compared over 5-year. Results Symptom scores improved from baseline after thermal therapy throughout the study (∆ IPSS = −11.1 at 3 months to −9.5 at 5 years). By 5 years, thermal therapy had the lowest rate of clinical progression at 4.6% while thermal therapy symptom improvement was similar to finasteride ( P = .10) and combination therapy (0.77) but remained superior to doxazosin ( P = .004) and placebo groups ( P = .035). Objective outcomes after Rezūm were more variable throughout follow-up, with peak flow showing benefit through year 3 only, and no benefit over placebo with respect to postvoid residual. Conclusion Water vapor thermal therapy patients experienced lower rates of clinical progression at 5-year post-treatment and thus may represent a benefit compared to pharmaceutical therapy for appropriately selected patients. Additionally, a single Rezūm treatment produces symptom score improvements that are initially superior to daily long-term medication, however, this advantage wanes over time.