Document Type
Article
Publication Date
7-17-2025
Publication Title
Urology
Pages
1-20
Publisher Name
Elsevier
Abstract
Objective: To compare 5-year clinical and subjective treatment outcomes of water vapor thermal therapy to 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, 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-years.
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=0.10) and combination therapy (0.77) but remained superior to doxazosin (p=0.004) and placebo groups (p= 0.035). 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 post void residual.
Conclusions: WVTT patients experienced lower rates of clinical progression at 5-years 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.
Recommended Citation
Long, Bronwyn; Cheema, Amandip; Copelan, Olivia; Joyce, Cara; Feffer, Marina; and McVary, Kevin T., "Five-Year Outcomes of Water Vapor Therapy versus Doxazosin, Finasteride, and Combination Therapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Cohort Data from the Medical Therapy of Prostatic Symptoms (MTOPS) Trial" (2025). Biostatistics Collaborative Core: Faculty Publications and Other Works. 45.
https://ecommons.luc.edu/biostatistics_facpubs/45
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Copyright Statement
© Elsevier, 2025.
Comments
Author Posting © Elsevier, 2025. This is the author's version of the work. It is posted here by permission of Elsevier for personal use, not for redistribution. The definitive version was published in Urology (July 17, 2025), https://doi.org/10.1016/j.urology.2025.07.016.