| Dr. Stanley Swierzewski says the use of microwave technology in the treatment of enlarged prostates isn’t exactly new. But recent advances are allowing the next generation of this science to be put to use in ways that can improve quality of life for many patient populations.
Swierzewski, director of the Continence Center at the hospital, is pioneering the use of microwave technology to treat a condition known as Benign Prostatic Hyperplasia, or BHP, a non-cancerous enlargement of the prostate affecting roughly 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of men over age 70.
Known as CoreTherm, the minimally invasive procedure uses microwaves to heat probes that effectively reduce the blood supply to the enlarged area of the prostate. As the affected area dies, the size of the prostate is reduced, relieving pressure on the urethra. Swierzewski, who is the first physician to utilize the procedure in the U.S., told The Healthcare News that it holds enormous potential in the treatment of BHP due to its speed, flexibility, and high degree of safety.
“What differentiates CoreTherm from other procedures is the added ability to customize treatment on a patient-by-patient basis,” he said, adding that the technique puts some of the enormous potential of evolving microwave technology on display.
A Better Way
Microwaves have been utilized in medicine for some time now, said Swierzewski, although their use has been restricted to prostate treatment and limited due primarily to safety issues. First-generation microwave technology was not as easy to monitor as what is now available, he explained, and its use often resulted in burns to areas of the body beyond the prostate.
“CoreTherm is second-generation technology and provides much more monitoring capability,” said Swierzewski, who first observed the procedure in Europe and was immediately impressed with its potential as an option in BHP treatment. “That makes it much safer than the older microwave procedure. It is also much more flexible in how it can be used on the prostate.”
CoreTherm, which is marketed in America by a Massachusetts firm, ACMI of Southborough, requires a special catheter to be inserted through the urethra. The catheter is the highway for a needle that carries three temperature probes that can be maneuvered and heated independently. Once in place, the probes heat to 50 to 60 degrees Centigrade (122 to 140 degrees Fahrenheit).
“At this temperature, they destroy blood vessels and reduce the blood supply to the area of the prostrate causing the problem,” Swierzewski explained. “ Just like a plant that isn’t watered, this part of the prostate will die, and its overall size will be reduced.”
Swierzewski noted that this is one more weapon in the arsenal against BPH. “There are several approaches to the treatment of BPH, including watchful waiting, removal of the prostate tissue, and traditional surgery,” he said, adding that CoreTherm provides higher levels of flexibility.
For instance, a similar but older procedure, Transurethral Needle Ablation (TUNA), uses radio frequencies to generate heat up to 149 degrees Centigrade (300 degrees Fahrenheit). However, it utilizes only two needle probes and is approved by the FDA only for prostates up to 60cc.
“With CoreTherm, I have done prostates up to 123cc — it can treat a much greater volume of tissue,” Swierzewski said. “It gives us more flexibility in how we treat an individual patient based on his lifestyle.” For instance, noting that one of the side effects of CoreTherm can be dry orgasms, something which doesn’t occur as often with TUNA, Swierzewski said that TUNA may be good for some younger patients, while CoreTherm is generally preferable for older patients with larger prostates.
Prior to CoreTherm, patients whose pros-tates were too large for TUNA were generally given a procedure known as a ‘transure-thral resection of the prostate,’ or TURP. A surgical procedure, it involves using a heated loop of wire to actually slice off pieces of the prostate. Naturally, this was done under full anesthesia and required a stay in the hospital. The recovery period was accordingly longer than with CoreTherm, which is done in the doctor’s office.
CoreTherm is performed with anesthesia only to the prostate itself (a prostate block). Beyond that, the patient is given Valium and Percocet to ease nervousness, but Swierzewski explained that in terms of the treatment itself, they are not necessary. This is due, at least in part, to the physician having so much control with CoreTherm technology that a side benefit is a reduction in patient discomfort.
It is also an amazingly quick procedure. Swierzewski performed the procedure on five patients the first day he started using it. On March 12, he did the procedure on eight patients. When asked just how long CoreTherm takes to perform, he noted that his office had just completed a study on that very topic. “The average was 16 minutes, 47 seconds, ranging from as little as eight minutes to 33 for the longest,” he said.
Breaking New Ground
Swierzewski’s enthusiasm for this new procedure is obvious. Since he started using it on Feb. 5, he has conducted 29 procedures. Only six others have been performed throughout the country, two each in Los Angeles, New York City, and Long Island.
Worldwide, CoreTherm is performed in Sweden (where it originated in 1995 at the University of Lund and is called ProstaLund), Poland, Denmark, France, Germany, and a number of countries in South America. It was approved by the U.S. Food and Drug Administration in January of this year, and Swierzewski performed the first procedure in the U.S. shortly thereafter.
To learn how to perform the treatment, Swierzewski traveled to Lund, Sweden for five days last September. He did his own first procedure in Copenhagen, Denmark before bringing his new knowledge to America.
Preliminary studies from Europe, where the procedure has been performed for eight years, indicate that 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of patients undergoing CoreTherm experience a noticeable improvement of symptoms within three to six months of treatment.
And Swierzewski believes it will enjoy a similar, if not better, track record in this country. |
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