NICE is asking for views on its plans to support widespread NHS use of an innovative device for treating enlarged prostate glands – benign prostatic hyperplasia – in a consultation opening this week.
The draft medical technology guidance provisionally recommends the use of the GreenLight XPS 180 W laser system in non-high-risk patients, which means men who don’t have an increased risk of bleeding, whose prostates are smaller than 100ml. and who don’t have urinary retention.
Prostate enlargement is a common condition in older men – around 60% of men aged 60 or over have the condition. 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 does not pose other direct risks to health.
The device - GreenLight XPS 180 W, manufactured by Boston Scientific - involves using a laser to vaporise excess prostate tissue, so easing the blocked urethra and leaving a clear channel for urine to flow. The claimed benefits of the system include a quicker return to normal activity following treatment, shorter hospital stay because the procedure can be done as a day case, and reduction in pain leading to improved quality of life.
The draft guidance notes that there is currently not enough evidence to support the use of the device in high-risk patients, so recommends further data collection. It also proposes that where GreenLight XPS 180 W is used, urology services should be redesigned to ensure that facilities for day-case surgery are available. An estimated saving of up £60 per patient could be made using this device when compared with the procedure transurethral resection of the prostate (TURP).
Professor Carole Longson MBE, director of the NICE Centre for Health Technology Evaluation, said: “This draft guidance on GreenLight XPS 180 W provisionally supports the use of this device for men with an enlarged prostate who don’t have high risk factors including increased risk of bleeding.
“The evidence examined by the independent Medical Technologies Advisory Committee indicates that using the device may benefit patients by needing a shorter hospital stay and quicker return to normal activities, and is also likely to benefit the NHS by saving money.
“There isn’t enough high-quality evidence to make provisional recommendations on GreenLight’s use in treating enlarged prostates in men classed as high risk, so we propose that specialists collaborate to collect and publish data for these patients to improve the evidence base. We welcome comments on the draft guidance as part of this consultation.”
The consultation closes on 23 February.