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a pilot study on the target microwave ablation for BPH.
The pilot trial completed 12 patients and all of them actually had significant improvement in terms of urinary symptoms.
Dear listeners,
welcome to another captivating episode of Prostatalk,
where we usually dive deep into the world of prostate cancer.
I'm your host Thomas and today we are taking a little detour down the prostate cancer pathway to explore the realm of benign prostatic hyperplasia,
BPH.
Don't worry,
we promise to keep it benignly entertaining.
Admit the serious discussion about prostate cancer,
BPH often feels like the overlooked cousin at the family reunion.
But fear not,
Dr.
Chu is here to turn the spotlight on BPH and provide insights.
Welcome on board Dr.
Peter Chu to Prostatalk,
where even the benign conditions get their moment in the spotlight.
Hello Dr.
Chu,
welcome again to this new episode of Prostatalk.
How are you since last time we have seen each other?
Hi Thomas,
I'm doing very good and the trials in both prostate cancer and the BPH are still ongoing.
I'm very excited to continue to work on these studies.
Perfect.
First of all,
could you please introduce yourself quickly for our listeners who don't know you yet?
I'm an academic urologist in Hong Kong,
in the Chinese University of Hong Kong.
My main interest is in prostate,
so both prostate cancer and benign prostatic hyperplasia.
I'm working on novel minimal invasive treatment options for both of these conditions.
Thanks for this introduction.
We used to talk about prostate cancer in this podcast,
but today we talk about benign...
prostatic hyperplasia.
Could you tell us some words about this disease?
Benign prostatic hyperplasia,
BPH,
is a very,
very common condition in men,
not always in elderly,
actually sometimes in middle age,
50-something.
It's actually much more common in prostate cancer and affecting so many thousands and tens of thousands of men.
The demand for optimal treatment and treatment for BPH with less morbidity.
is in high demand.
You mentioned that it's most common that prostate cancer.
How common is these conditions and what are some key characteristics of patients who are affected by BPH?
As men age,
say beyond 60 or 70,
like two or three or even more men will be affected with some urinary symptoms that is mostly related to the benign prostate hyperplasia.
As said,
this
problem is very very common in the past most of these men would take drugs some medications to improve the symptoms which work for some time but eventually the drugs will not work so well in some men and they will need to consider surgical treatment and in the past surgical treatment like transurethral resection of the prostate terp carries some morbidity and a lot of men are actually very resistant in receiving the terp because
part of the sexual function will be gone after receiving this treatment.
Men would tolerate a lot of these symptoms and keep on the medications.
And by the way,
the medications also harm the sexual function too.
These men are in a pretty frustrated status,
actually.
I know that there are sometimes patients or people directly concerned by prostate disease who listen to us.
So my question is,
what are the typical symptoms of BPH that patients should be aware of?
Are there...
any warning sign that indicate the need of immediate medical attention?
Right.
So most of these men with BPH have a range of symptoms.
They don't necessarily have all of them,
but they might have one or two or more.
So that includes usually slow stream very commonly,
and they're taking much longer time to finish their pee.
And after they pee,
they don't feel like they've completely emptied the bladder.
On the other hand,
there are also symptoms of urgency,
frequency,
and nocturia,
which are all quite bothersome to men.
These symptoms on its own or in combination would affect the quality of life of these men.
Definitely.
And many of them,
if they're very mild,
then they might still observe or what we call tolerate the symptoms.
But further on,
they need to take drugs.
And afterwards,
as I've said.
they may need to consider surgery.
What are the current treatment options available for patients with BPH?
Could you briefly describe each option and discuss their efficacy and potential side effects?
In terms of surgical treatment for BPH,
there are actually a long list of treatment options.
Okay.
Well,
this depends on the size of the prostate and any complications related to the BPH.
In general,
for patients that has not had any retention of urine or severe complication like obstructive uropathy and impaired renal function,
so mainly for lower urinary tract symptoms,
the...
The gold standard or the most so-called gold standard or most commonly performed surgical treatment is the transurethral resection of prostate or TURP.
In recent years,
for prostates of medium-sized,
like between 30 to 80 gram,
there are actually a lot of new treatment options like intraprosthetic injection of steam or putting in urethral implants like the prosthetic urethral lift or even putting in temporary stents like the ITIN.
So there are actually a lot of...
options out there but what I'm working on now the microwave ablation is another very exciting new treatment coming up.
When determining the most appropriate treatment for a patient with BPH what factors do you take into consideration?
Are there certain patient characteristics or preferences that influence your decision making process?
So the consideration of surgical treatment would depend on firstly the prostate size so
for very large prostates,
like more than 80 or 100 grams,
TURP or even inuclation of the prostate will be more appropriate.
But most men actually do not have the prostate that is so big.
So most men with the BPH symptoms that requires treatment would have prostate size of less than 80 grams.
So this size is a consideration.
Secondly,
is there any complication like recurring infection,
bladder stone,
retention of urine?
And
and impaired renal function related to obstructive uropathy due to BPH obstruction.
So these are all considerations of which treatment type that we will choose for the patient.
Are there any recent advancement of emerging treatments in the field of BPH that you find particularly promising or not worthy?
I've mentioned just now there are a few minimally invasive surgical treatment for BPH missed.
As said,
I've talked about a steam injection.
and the prosthetic urethral lift or temporary prosthetic stents.
These are all useful techniques to help.
They all have their goods and bads.
And therefore,
we are now actually exploring further options down the road to see if there are any better options for the patients.
And for the record,
last time,
we talked about targeted micro-revablation for prostate cancer.
And today,
I would like to talk with you about the use of this energy for benign...
prostatic hyperplasia.
Could you please remind us what is targeted microwave technology?
This is a needle ablation done through transparent insertion of that very small microwave needle of 17 gauge.
And the role of it is to perform ablation of prostate tissue such that the ablated area will shrink and subsequently prostate volume will reduce and the pressure.
on the prostate urethra will decrease in order to achieve a reduction of bladder outlet obstruction.
And in the end,
we would like to achieve a reduction of obstruction,
improvement of urinary flow and reduction of urinary symptoms in these patients.
And some studies have already been published for prostate cancer.
And if
I'm not wrong,
I could see a few papers from you,
at last,
EAU and AUA 2024.
So you have just finished a trial for targeted microwave ablation for benign prostatic hyperplasia.
Is that right?
We have done a pilot study on the targeted microwave ablation for BPH.
The pilot trial completed 12 patients and all of them actually had significant improvement in terms of urinary symptoms and the flow of the urine as tested objectively.
We are now going to expand this treatment option into another phase.
in a clinical trial so we can treat more patients.
And we actually have a plan of subsequent trials coming up to help us to know better the goods and bads of this treatment.
Okay.
And so what brings you to test targeted microevaporation technology for this pathology?
So we have been doing a lot of steam injection in Hong Kong for BPH.
It's actually giving us some good results too,
but at the same time it...
I mean,
steam is injected transurethrally through the prostate urethra into the prostate.
So sometimes it would cause quite a lot of early periurethral edema on the prostate and sometimes hematuria in the first few days.
And so we are exploring newer options that we can avoid puncturing the prostate urethra,
and that is through the transperineal skin directly into the prostate in order to do the ablation.
This is quite early on in the clinical trial,
but we are quite optimistic.
that this is going to be a very exciting new treatment.
Definitely exciting.
Is everybody concerned by this treatment or do you have any criterias?
In the clinical trial,
we choose patients who are at least moderate to severe urinary symptoms,
prostate size of between 30 to 80 gram,
which is actually the inclusion criteria of most other minimally invasive surgical treatments out there.
We plan to compare these results with the results of the other modalities and see whether there is any advantage of this microwave ablation over the other treatments.
And may I ask,
what are the results as far today?
As demonstrated in a few abstract papers,
the initial results of the microwave ablation were very encouraging.
There was significant improvement of the urinary symptoms in terms of the reduction of symptom score.
Thank you.
from
28 down to about 8.
So this was a huge improvement of 20
IPSS points,
which is not commonly seen in other MIST trials.
We are looking forward to the next trial which would have more patients and this is going to be conducted in Europe.
And we are also lining up the third trial in comparing with other BPH treatments.
It's quite encouraging,
definitely.
And do you have already any feedback from the patient's comfort?
As I've said,
all 12 patients reported improvement,
some huge improvement,
some would be like moderate improvements,
but in the end,
it's all with very good improvements.
There was no deterioration of the sexual function and no major morbidity.
Only in the first few weeks,
a couple of patients have hematuria,
but then...
Afterwards,
most patients do very well.
This actually prompts us to do subsequent trials.
It is very interesting.
Before to finish,
what are you working on right now?
And what are your plans for the future?
As I said,
we are now waiting for the results from the European trial,
which is the first trial in Europe on TMA for BPH.
And I'm now gathering more centers to participate in.
next phase of the trial,
which is coming up,
and we're going to do a comparative trial with other treatment options.
So yeah,
this is the plan.
We will follow that with very intentions.
So thank you,
Dr.
Chu,
for this stunning discussion.
I would like to say thank you because it was a pleasure to have you for this second podcast,
and I hope to see you soon in Prostato.
Thank you and have a good day.