No scalpel: minimally invasive breakthrough for men‰Ûªs enlarged prostates improves symptoms


 A new interventional radiology treatment that blocks blood supply to men’s enlarged prostate glands shows comparable clinical results to transurethral resection of the prostate (TURP), considered the most common treatment. However, this minimally invasive treatment—prostatic artery embolisation—has none of the risks associated with TURP, such as sexual dysfunction, urinary incontinence, blood loss and retrograde ejaculation, noted researchers at the Society of Interventional Radiology’s 36th Annual Scientific Meeting in Chicago.


“Benign prostatic hyperplasia (BPH) is so common that it has been said that all men will have an enlarged prostate if they live long enough. I believe that a minimally invasive interventional radiology treatment—prostatic artery embolisation (PAE)—will be the future treatment for benign prostatic hyperplasia or men’s noncancerous enlarged prostates,” noted João Martins Pisco, chief radiologist, Hospital Pulido Valente and director of interventional radiology at St. Louis Hospital, Lisbon, Portugal.


“Prostatic artery embolisation blocks blood supply to treat noncancerous benign prostatic hyperplasia. This study is significant because it shows comparable clinical results to transurethral resection of the prostate —without the risks of surgery, such as sexual dysfunction, urinary incontinence, blood loss and retrograde ejaculation,” added Pisco, professor at the Faculty of Medical Sciences, New University of Lisbon. “While the gold standard treatment for enlarged prostates has been TURP, minimally invasive prostatic artery embolisation is safe, performed under local anesthesia and has comparable clinical results—without TURP’s limitations and risks,” said Pisco.


The interventional radiologist indicated that prostatic artery embolisation patients experienced symptom improvement comparable to TURP; however, certain urodynamic results (such as flow rate of the urinary stream) did not improve as much as with TURP.


TURP can be performed only on prostates smaller than 60–80 cubic centimeters; there is no size limitation for prostatic artery embolisation treatment, said Pisco. “The best results are obtained on patients with prostates larger than 60 cubic centimeters and with very severe symptoms,” he added. “Pelvic arterial embolisation may be the only feasible and effective treatment for benign prostatic hyperplasia in those men who cannot have TURP due to the size of their prostate (80+ cubic centimeters) or because it is inadvisable for them to undergo general anaesthesia,” said Pisco.


An estimated 19 million men in USA have symptomatic benign prostatic hyperplasia, (14 million undiagnosed; 2 million diagnosed but untreated). Statistics show that a small amount of prostate enlargement is present in many men over age 40, as many as 50% experience symptoms of an enlarged prostate by age 60 and more than 90% of men over the age of 85 will report symptoms.


“The men who were treated with prostatic artery embolisation showed significant clinical improvement,” said Pisco. In this study, 84 men (ranging in ages from 52 to 85) with symptomatic benign prostatic hyperplasia underwent prostatic artery embolisation after failing other medical treatments for at least six months, said Pisco. The men were followed for more than nine months (on average), and prostatic artery embolisation was found to be technically successful in 98.5% of the patients—with 77 men showing “excellent” improvement, six men “slight improvement” (but needing no medications) and one experiencing no improvement (due to receiving an incomplete embolisation), he added. Two hours after prostatic artery embolisation, most men were passing urine less frequently. It was impossible to embolise both prostate arteries in the men showing “slight improvement” due to advanced atherosclerosis, said Pisco.