Evaluating the New Technology
The new, minimally invasive procedures have some advantages over traditional surgery, but they must be viewed with caution. The long-term safety and durability of these procedures needs to be carefully evaluated before they are accepted as reasonable alternatives.
Randomized studies are needed to determine whether the new technology really does compare favorably to other tried-and-true treatment options, particularly transurethral resection of the prostate (TURP). A new technology may not closely approach TURP in terms of improving the peak urinary flow rate, but if the new procedure can provide a reasonable improvement with fewer risks, then it may be a legitimate option.
Studies on the long-term effectiveness of the newer technologies are also needed. Until these studies are reported, it is very difficult to say whether a newer technique is better or worse than drug therapy, surgery, or another minimally invasive procedure. If you are thinking about trying one of these new surgical techniques, be sure to discuss the evidence regarding the various treatment options with your primary healthcare practitioner or urologist.
The Placebo Effect
The placebo effect in drug trials of BPH is well established: Nearly one-half of men respond favorably to placebos, and the effect lasts for about six months before it begins to wear off.
With surgical procedures, it is more difficult to perform placebo treatments, especially ones that are double-blind. But a recent study used a sophisticated, sham microwave therapy in double-blind fashion, along with an untreated control group, to evaluate the placebo effect associated with a procedure. The results showed that symptom scores improved about equally in the sham and real microwave therapy groups but not in the untreated control group. This suggests that there is a placebo effect with surgical procedures, too.
