Comparing Rezum Therapy to Drugs for Enlarged Prostate Treatment

One-time treatment of benign prostatic hyperplasia (BPH) with a water vapor thermal therapy (Rezum System) was found to provide  better symptom relief scores and five times lower clinical progression rates when compared with long-term drug treatment. Results of the study, which appeared recently in The Journal of Urology, are important given that nearly two-thirds of men with BPH fail to continue their drug treatment after one year.

What is Rezum therapy?

Rezum System is a minimally invasive treatment procedure that can be performed in a clinic or outpatient facility. The procedure involves administering stored thermal energy in water vapor (steam) to treat excessive prostate tissue associated with symptoms of BPH, such as urinary urgency, weak urinary stream, straining, frequently getting up at night to urinate, and urinary frequency, among others. No general anesthesia is needed, and men typically can return to their regular activities within a few days of the procedure. Symptom improvement is generally noted within two weeks.

More specifically, the steam is targeted on the excessive prostate tissue and causes the offensive prostate tissue cells to die. Over the few weeks following the procedure, the body’s natural healing response rids the body of the destroyed tissue, which in turn shrinks the prostate. As the excess tissue is removed, the urethra is able to open back up, urinary flow improves, and BPH symptoms fade away.

An added bonus is that thermal therapy is not associated with a negative impact on sexual function, as can occur with some drugs for BPH.

Thermal therapy vs long-term drug treatment study

The participants were cohorts from the Medical Therapy of Prostatic Symptoms (MTOPS) study, in which men were treated with the drugs doxazosin, finasteride, or both. They were compared with participants in a randomized, controlled trial of the Rezum System. Outcomes from the two groups were compared over three years and included analysis of symptom changes and rates of clinical progression.

The findings were as follows:

  • Thermal therapy resulted in an improvement in symptom scores of about 50 percent over the three years
  • Symptom improvement in the thermal therapy group was greater than use of either drug alone but was similar to that experienced by those who received the combined drugs
  • Peak flow rate improved after use of doxazosin and thermal therapy, but Rezum was better than finasteride at two years and combination drugs at one year
  • Rates of clinical progression were about five times lower over three years for a single thermal therapy procedure versus any of the drug treatments

Therefore, the authors concluded that a single water vapor thermal therapy procedure resulted in effective and long-lasting improvements in symptoms and better clinical progression rates when compared with daily, long-term use of drug therapy.

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Why this finding is important

Given that nearly two-thirds of men with BPH who are prescribed medication for BPH stop taking their drugs within a year of getting their regimen, an alternative such as water vapor thermal therapy can be considered. Men with BPH who are reviewing their treatment options should add thermal therapy to the list of candidates.


Gupta N et al. 3-year treatment outcomes of water vapor thermal therapy (Rezum System) compared to doxazosin, finasteride and combination drug therapy for men with benign prostatic hyperplasia: cohort data from the Medical Therapy of Prostatic Symptoms (MTOPS) Trial. The Journal of Urology 2018 Feb 27

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