The prostate is a gland located around the urinary outlet of the bladder in the male body. About the size of a walnut, the prostate is comprised of two side-by-side lobes connected in the front by a narrowed part of the gland and from behind by a middle lobe that lies above and between the ejaculatory ducts. The gland secretes a milky fluid that is discharged by excretory ducts into the prostatic urethra at the time of emission of semen.

Conditions relating to the prostate gland include, but are not limited to:

Benign prostatic hyperplasia (BPH): The prostate has become enlarged, narrowing the urethra, which causes prostatism and is noted by nocturia, hesitancy, slow stream, terminal dribbling and frequency of urination. Surgical removal of the prostate may be required.

Prostatitis: The prostate has become inflamed due to infection or non-infectious inflammation causing pain in the bladder region, frequency of urination and blood in the urine. Surgery is rarely indicated or helpful. Instead, the disease is generally treated with antibiotics and/or anti-inflammatory medication.

Prostatic carcinoma: Carcinoma of the prostate is one of the most common malignancies in men. In its early stages, most men show no physical signs of malignancy. The disease may be identified by a pathologist when prostate tissue is removed for relief of benign prostatic hyperplasia. More advanced cancer is detected by a hard nodule on the prostate felt during a rectal exam. The diagnosis of cancer is usually confirmed by a needle biopsy. The method of treatment depends upon the extent of the malignancy, but generally involves radiation therapy, radical prostatectomy, or hormonal therapy.

Numerous and varied procedures have been attempted for treatment of the above conditions. They include, but are not limited to:

Cryosurgical ablation of the prostate (55873): A probe, which is used to apply a freezing material such as liquid nitrogen, is inserted through an opening in the perineum and guided by transrectal ultrasonography. Cryosurgical ablation of the prostate is considered to be eligible when performed as the primary treatment for prostate cancer.

Transurethral microwave thermotherapy of the prostate (53850): This procedure is a form of thermal therapy that uses microwaves as the heat source to treat symptomatic benign prostatic hyperplasia. A transurethral applicator and a rectal probe are inserted. The specially designed catheter allows the application of microwave heat energy while two cooling channels within the catheter simultaneously circulate coolant water to maintain appropriate temperatures. TUMT is considered to be an eligible service.

Transurethral needle ablation (TUNA) of the prostate (53852): This procedure is a form of thermal therapy that uses radiofrequency energy for the treatment of symptomatic benign prostatic hyperplasia. It is also known as transurethral radiofrequency needle ablation (RFNA) of the prostate. This procedure uses a specially designed catheter inserted through the penis to the level of the prostate. Small needles are inserted through the catheter into the prostate to transmit radiofrequency energy which destroys the prostatic tissue that is blocking the flow of urine. Transurethral needle ablation of the prostate is considered to be an eligible service.

Laser ablation of the prostate (52647, 52648): This procedure is commonly performed to treat patients with benign prostatic hyperplasia. Laser energy is delivered to the prostate in three ways. One is the transurethral ultrasound-guided laser-induced prostatectomy (or TULIP procedure), another is the "free hand" application of laser energy through a lateral firing fiber. A third method is by direct contact of the prostate tissue with a laser probe to ablate or photocoagulate the tissue. Laser resection of the prostate by any of these methods is eligible.

Transurethral balloon dilation of the prostate (52510): Transurethral balloon dilation of the prostate is a non-surgical, therapeutic procedure for the treatment of symptomatic benign prostatic hyperplasia (BPH). A flexible balloon catheter is placed in the urethra at the level of the prostate above the external sphincter. The balloon is then inflated for a short period of time to distend the prostatic urethra. This widening process is intended to relieve the symptoms of benign prostatic hyperplasia. This procedure is investigational and as such, it is ineligible for payment.

Transurethral cryosurgical removal of the prostate: The prostate is frozen and removed through the urethra for relief of benign prostatic hyperplasia. This procedure is a procedure of questionable current usefulness (POQCU). Refer to Medical Policy Bulletin G-21.

Transurethral resection (TUR) (52601-52640): An operation to relieve bladder neck and urethral obstruction is performed via the urethra in which a portion of the prostate gland is removed through the penis. This procedure is the most common technique for relief of benign prostatic hyperplasia. It is considered to be an eligible service.

For information on lymphadenectomy with implantation of I-125 seeds, see Medical Policy Bulletin S-27.

For information on post-operative bleeding following TUR of the prostate, see Medical Policy Bulletin S-58.

For information on prostatic massage, see Medical Policy Bulletin V-31.

For information on transrectal ultrasound of the prostate, see Medical Policy Bulletin X-25.

Cryosurgery of the prostate continues to be considered investigational for salvage therapy for local failures after radical prostatectomy, external beam irradiation, and brachytherapy.

Transurethral destruction of prostate tissue, by radiofrequency thermotherapy (also known as transurethral needle ablation (TUNA) of the prostate)(code 53852) is not a covered benefit.

PRN References

10/1993, Treatment of the prostate
08/1994, Cryosurgery of the prostate
08/1996, Transurethral microwave thermotherapy
02/1997, Laser resection of the prostate
06/1998, Transurethral needle ablation of the prostate considered investigational
10/1998, Transurethral microwave thermotherapy of the prostate
10/1999, Transurethral radiofrequency needle ablation of the prostate now covered
02/2000, Cryosurgical ablation of the prostate now covered

Preliminary Outcomes Following Cryosurgical Ablation of the Prostate in Patients with Clinically Localized Prostate Cancer, The Journal of Urology, Vol. 159, 2/98

Outcome and Safety of Transrectal US-Guided Percutaneous Cryotherapy for Localized Prostate Cancer, Journal of Vascular Interventional Radiology, Vol. 10, 2/99