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Symptoms not a Barrier to Success for Nonsurgical Prostate Artery Embolization

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According to research being presented at the Society of Radiology" href="/tag/Interventional-Radiology.html">Interventional Radiology's 39th Annual Scientific Meeting, shrinking the prostate without surgery can lead to long-term relief in men with this common condition which results in irritating symptoms such as frequent urination. In fact, 72 percent of men experienced improvement three years after having a new, minimally invasive, image-guided treatment performed by interventional radiologists called prostate artery embolization (PAE).

"The results of prostate artery embolization (PAE) are similar to surgery but with fewer complications. Patients are discharged three to six hours after the treatment with most of the individuals we've treated noting almost immediate symptom relief. I believe PAE could eventually become standard treatment for enlarged prostate," said lead author of the study and director of radiology at Saint Louis Hospital, Lisbon, Portugal, Martins Pisco, M.D., Ph.D.

As men age, their prostate gland slowly begins to enlarge and may press on the urethra, causing the flow of urine to be slower and less forceful. Enlarged prostates cause urinary frequency, urgency, passing urine more often (particularly at night), weakened stream, and incomplete bladder emptying.

"Such symptoms can have significant negative impact in quality of life, leading many men to seek treatment," said Pisco, citing that this condition affects more than half of men by age 60.

“The standard treatment for benign prostatic hyperplasia or BPH, which is the medical name for enlarged prostate, is surgery, which requires general anesthesia and can cause complications, such as urinary incontinence, sexual dysfunction, impotence and retrograde ejaculation, in which semen enters into the bladder. PAE, which can be performed under local anesthesia, involves temporarily blocking blood flow to the arteries that supply the prostate, a treatment called embolization. Our study confirmed that PAE does not cause sexual dysfunction and preserves fertility,” explained Pisco.

Pisco also indicated that such a study was the largest of its kind. “In fact, 148 (31.6 percent) of our treated patients reported improved sexual function. We also found that the larger the prostate and the more severe the symptoms are, the better the results of PAE," noted Pisco.

Success rates in 469 patients (ages 45-89) treated with PAE were as follows: 87.2 percent at three months, 80.2 percent at 18 months and 72.3 percent at three years. One patient suffered from lack of blood flow to the bladder wall that was then corrected by surgery, and one patient had pain that lasted three months. In cases where the problem recurred, it often could be re-treated with PAE.

With PAE, an interventional radiologist makes a small incision in the groin and directs a catheter to the prostate artery. Microscopic beads are released into the artery, where they lodge and temporarily block blood flow to the prostate, causing it to shrink. PAE currently is the focus of several U.S. trials.

"These results are very promising for American men," said SIR President-elect James B. Spies, M.D., MPH, FSIR.

Spies acts as a principal investigator on one the ongoing U.S. PAE trials, noted that this treatment is an advanced embolization procedure requiring meticulous training and a detailed knowledge of the prostate anatomy and surrounding vessels.

"Interventional radiologists are leaders in bringing forth new treatments such as these responsibly," said Spies, who also serves as chair of the radiology department at Medstar Georgetown University Hospital and professor of radiology at Georgetown University Medical Center in Washington, D.C.

Spies concludes that additional study is called for to further establish the safety, efficacy, and durability of this particular treatment before it becomes widely available in clinical practice.a

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