Enlarged prostate, or benign prostatic hyperplasia (BPH), affects most men after middle age, causing frequent nighttime trips to the bathroom and health problems. Now early findings from a small US study presented at a conference this week suggests a minimally-invasive treatment called prostatic artery embolization (PAE), which shrinks the prostate back to its more youthful size by reducing blood flow to it, may provide significant relief from symptoms and help men avoid surgery.
Study lead author, Sandeep Bagla of Inova Alexandria Hospital in Alexandria, Virginia, says in a press statement:
“Nearly all men eventually suffer from an enlarged prostate as they age, and this treatment is almost like turning back the clock and giving them the prostate of their youth.”
The preliminary study results are being presented this week at the Society of Interventional Radiology’s 38th Annual Scientific Meeting in New Orleans.
Bagla explains that medications don’t really help with BPH, and while surgery can correct the problem, it carries risks and often comes with significant side effects (such as impotence and urine leakage).
“PAE is a minimally invasive alternative with low risk that appears to reduce symptoms in the overwhelming majority of patients,” says Bagla, who is an interventional radiologist in the hospital’s department of cardiovascular and interventional radiology.
The prostate is an organ that sits just below the bladder in men, and its main function is to produce fluid which protects and enriches sperm. The urethra, the tube that carries urine from the bladder to outside the body, passes through the prostate.
In healthy young men, the prostate is quite small, about the size of a walnut, giving plenty of room for the urethra to be its normal size. But as men get older, many will experience Benign Prostatic Hyperplasia (BPH), where due to excess cell growth the prostate enlarges and begins to squeeze the urethra and interfere with urine flow. In very severe cases, affected men cannot urinate at all.
BPH affects more than half of 50-year-old men and more than 80% of 80-year-old men. It is not life-threatening but causes unpleasant and sometimes aggravating symptoms such as frequent urination at night, weak urine flow, and inability to empty the bladder completely. If untreated the condition can result in bladder stones, poor kidney function and infection.
BPH can be treated with antibiotics, or in more developed cases, a surgical procedure called trans urethral resection of the prostate (TURP) to widen the urethral passage. This is an invasive procedure carried out under general anaesthetic, where the surgeon inserts an instrument through the penis and removes some of the enlarged prostate. This is normally followed by a stay in hospital with a catheter installed during recovery.
Intervention radiologists like Bagla treat a variety of cancerous and non-cancerous conditions with a less invasive procedure called “embolization”, where they block the flow of blood to the tumor or affected organ, causing it to shrink. In the case of the prostate, the procedure is called prostatic artery embolization (PAE). PAE shrinks the prostate and gives back the squeezed urethra the large passageway it once had.
Bagla and colleagues say the early results of their study are very promising. However, they have not yet reported their findings in a peer-reviewed journal.
At the conference they report that 13 out of 14 participants (92%) who received PAE for their enlarged prostate, noticed a significant reduction in symptoms after one month.
None of the participants suffered major side effects, such as impotence, infection, or urine leakage, and most went home on the same day of treatment.
Bagla says the participants reported “a true lifestyle-changing effect after this treatment, with some men stopping medication for their prostate symptoms altogether”, and adds that:
“Patients who have not been helped by surgery or laser treatments have benefited. Since the treatment does not involve placing a catheter or device into the penis, there is no risk of narrowing of the urethra, incontinence or bleeding.”
He says their preliminary results confirm those reported by interventional radiologists in Europe and South America.
The team is already enrolling 30 participants for the first prospective US study to evaluate PAE as a treatment for enlarged prostate. They hope to complete the study, which will examine the safety and clinical effectiveness of PAE, by autumn of 2013.
After that they will follow patients for another two years to evaluate long term results.
Bagla says “all patients are looking for the least invasive treatment with lowest risk,” and that millions of men don’t like the idea of surgery because understandably they don’t want to risk being left with side effects like urine leak, impotence or other complications that may arise from invasive procedures.
In 2011, a study involving 1,000 clinicians in 15 countries reported in the urology journal BJUI that men with BPH are hospitalized and treated differently depending on where they live.
Written by Catharine Paddock PhD