NICE recommends laser device for men with enlarged prostate

GreenLight XPS laser system could save NHS £3m

The GreenLight XPS laser system

Thousands of men could benefit from a new laser treatment for an enlarged prostate, as recommended in new guidance from NICE, published this week.

The Medical Technology Guidance supports using the GreenLight XPS laser system in patients who aren’t at high risk of complications from treatment. This means men who don’t have an increased risk of bleeding, whose prostates are smaller than 100ml, and who don’t have urinary retention. For men who are high risk, there are limited alternative treatment options depending on their clinical situation.

An estimated 13,600 men with enlarged prostates could benefit from treatment with this device, and it could save the NHS millions of pounds each year.

Prostate enlargement – also called benign prostatic hyperplasia – is a common condition in older men; around 60% of men aged 60 or over suffer from it. An enlarged prostate can push against the urethra, making it difficult for a man to pass urine. It may also lead to repeated urinary tract infections, urinary retention, and sleep problems due to the urge to urinate in the night, but the condition doesn’t pose other direct risks to health.

The device, GreenLight XPS, manufactured by Boston Scientific, involves using a laser to vaporise excess prostate tissue, which eases the blocked urethra and leaves a clear channel for urine to flow. The benefits of the system include a quicker return to normal activity following treatment and a shorter period of time in hospital because the procedure can be done as a day case. The NHS could save up to an estimated £3m by using this device when compared with the commonly-used procedure transurethral resection of the prostate (TURP), because TURP requires an overnight stay in hospital.

The guidance notes that there’s currently insufficient evidence to support the use of the device in high-risk patients, so it recommends that specialists should collect information on outcomes if they do use the device in these patients. It also recommends that where GreenLight XPS is used, urology services should be redesigned to ensure day-case surgery is available.

Professor Carole Longson MBE, director of the NICE Centre for Health Technology Evaluation, said: “While benign enlarged prostates may not be life threatening, the condition can impact on men’s lives significantly.

“A procedure to reduce the amount of excess prostate tissue can improve the quality of life for men. Using the GreenLight XPS is more convenient for patients than other surgical procedures as they don’t need to stay in hospital overnight and they can return to normal activity faster.

“We recommend that specialists collaborate to collect and publish data if GreenLight XPS is used in treating enlarged prostates in men classed as high risk. This will help improve the evidence base and could enable future recommendations on its use in these patients.”

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