AS SENIOR MEMBERS OF the baby-boom generation began turning 50 this year, some of the men no doubt discovered that a stop at the urinal wasn't what it used to be. Roughly a third of American males over 50 suffer from prostate enlargement (officially benign prostatic hyperplasia, or BPH). Though less serious than the prostate cancer that killed Timothy Leary last spring, BPH can turn urination into an agonizing round-the-clock task. Drug treatment brings only modest relief--and though surgery is more effective, it's also costly, painful and fraught with possible side effects. But a new procedure called TUNA (for transurethral needle ablation) should brighten the picture in the coming year. Using a device developed by Vidamed of Menlo Park, Calif., doctors can now shrink a man's prostate without putting him in the hospital. The 45-minute procedure requires only a local anesthetic. It costs roughly half as much as surgery. And because it's less invasive, it's also less risky. Dr. Michael Naslund, director of the University of Maryland Prostate Center, calls TUNA ""the new state of the art.''
The prostate is a chestnut-size gland that produces a lubricant for semen. It sits like a collar on the urethra (the urinary tube), just below the bladder. And when it swells with age, it has the effect of a clamp on a hose. For the past five decades the standard remedy for BPH has been a procedure called TURP (transurethral resection of the prostate). Working with an anesthesiologist in an operating room, a surgeon pushes a catheter up the urethra and uses a small wire loop to cut away the excess prostatic tissue. Though highly effective, the operation costs roughly $6,000 and has several drawbacks. Many patients have to wear catheters and bags for several days while they recuperate. Up to 90 percent are left ejaculating backward into their bladders (not a big problem unless one is still trying to father children). And because TURP can damage nearby nerves and muscles, 2 to 5 percent of patients are left partially impotent or incontinent.
TUNA brings similar relief without the hazard or annoyance. As in the TURP procedure, a catheter goes in through the urethra. But instead of a wire loop, the TUNA device employs a tiny needle that can penetrate the prostate without damaging the wall of the urethra (chart). Monitoring his movements through a tiny video camera housed in the catheter, the urologist guides the needle into place. Then he releases controlled bursts of radio-frequency radiation, which incinerate excess prostate tissue without affecting nearby nerves, muscles or membranes. In six weeks to three months the body reabsorbs the dead prostatic tissue, and the urethra gains some breathing room. The procedure is slightly less thorough than TURP, says Dr. Joseph Oesterling, chairman of urology at the University of Michigan. But most men are pleased with the results. Clinical studies have found virtually no side effects--and because TUNA requires no hospitalization, the typical cost is only $3,500.
Few prostate patients are as discriminating as Dr. Richard Fein. When the 61-year-old retired urologist developed BPH two years ago, he first tried treating it with medication. Unfortunately, one drug shrank his libido instead of his prostate, and another one made him dizzy. Having performed 1,000 TURP operations himself, Fein knew he didn't want surgery. So he enrolled in a study of the TUNA procedure, which was still experimental. ""It's gone beyond my wildest expectations,'' he says. He may not shoot like a teenager, but, as he puts it, ""I don't have to know every bathroom between here and downtown Miami.'' Anyone would call that progress.
Some 14 million American men suffer from benign swelling of the prostate. A new procedure called TUNA could make treatment easier than ever before.