While treatment options for prostate problems have expanded over the last few yearsthe German Institute for Quality and Efficiency in Health Care warns that some new surgical techniques are being heavily promoted without first having been adequately evaluated.
For many men, the symptoms of enlarged prostate are just annoying. But for others, it means going to the bathroom so often that a good night's sleep has become a thing of the past. Most of the time the cause is an enlarged prostate, a condition doctors call "benign prostatic hyperplasia". One in five men in their 50s are affected and the majority of men in their 70s will have symptoms.
The treatment choices have greatly expanded in recent years. However IQWiG's evaluation of the research raises questions about many surgical techniques.
"Not everything that is new is necessarily an improvement," said the Institute's Director, Professor Peter Sawicki. "Better information is necessary to help men and their doctors weigh up the advantages and disadvantages of the various treatments."
To that end, IQWiG has published easy-to-understand summaries of the research in this area on IQWiG's website. It includes information on managing prostate symptoms, medicines and surgical options as well as the stories of men who have used different treatments.
According to researchers' best estimates, about 3 out of every 10 men in Europe will handle their prostate symptoms without medication or surgery and perhaps only 1 in 10 will have surgery. The rest will use medications, including herbal medicines, if their symptoms become too troublesome.
"In Germany and other European countries, drugs called alpha blockers have taken over as the most common treatment choice for benign prostatic hyperplasia," said Sawicki. "These drugs were originally developed to reduce high blood pressure, but prostate symptoms will also improve at least a little for 60 percent of the men who use them."
In analyzing the research results for surgery, the Institute concluded that the original surgical procedures still have the best results. A few of the new surgical techniques appear to have good results -- for example, possibly shortening the time needed in the hospital. But more research is needed to confirm this. And most of the new techniques use equipment that has not yet been tested in enough trials.
"Prostate surgery can be very effective, but the adverse effects are a major concern for many men. Some of the newer techniques might have fewer adverse effects, but they may be so much less effective that the symptoms return, as bad as ever, within a couple of years," Sawicki said.
