Getting up repeatedly in the middle of the night with an urgent need to urinate is a symptom of benign prostatic hyperplasia (BPH), also referred to as “enlarged prostate.” BPH is one of the most common health problems experienced by men, affecting half of all men between 51 and 60 years of age and up to 90% of men older than 80.¹

For the millions of men in the U.S. who are currently suffering from BPH, frequent urination is just one of the symptoms. When the prostate gland grows, it presses against the urethra and bladder. This can cause painful urination, incontinence, reduced sex drive and even erectile dysfunction. One study showed that 95% of men with moderate BPH are unhappy and do not wish to spend the rest of their lives suffering from these symptoms.² 

Surgical treatment

Until recently, men had one treatment option for BPH—a surgery called transurethral resection of the prostate (TURP).  During the surgery, an instrument called a resectoscope is inserted through the tip of the penis and into the urethra, the tube that carries urine from the bladder. The resectoscope is then advanced to the prostate gland where it is used to remove a portion of the prostate gland using an electric current or a laser. Around 150,000 men have this surgery every year.

TURP is a major surgery, with serious risks. Complications are also surprisingly common, and include bladder injury, inflammation, infection, bleeding and a loss of erections. 65 out of 100 men who have the surgery experience retrograde ejaculation—an unfortunate condition where semen goes into the bladder and not out of the penis. 

Another complication of TURP is painful or difficult urination, which is the one of the problems the surgery is intended to alleviate!

Anyone contemplating surgery wonders, are the risks and complications worth it? While most men who have this surgery do achieve symptom relief, a full one-quarter of them will achieve only a small reduction in BPH symptoms. Furthermore, prostate regrowth or scarring is common after TURP, with approximately 10% requiring additional surgery within 5 years. 

A new and less invasive option

Fortunately, there is now a better alternative to TURP for most men. In 2018 the FDA approved prostate artery embolization (PAE) for the treatment of BPH. 

For men with moderate to severe BPH symptoms, PAE offers a highly effective and less invasive alternative to surgery, especially in patients with an enlarged gland and/or who are not ideal candidates for TURP.

PAE is performed by an interventional radiologist who, using imaging guidance, inserts a tiny catheter into an artery in the patient’s upper thigh or wrist, and then guides it through the body’s vascular system to the arteries supplying blood to the prostate. Tiny beads called ‘microspheres’ are released through the catheter and into the arteries, blocking blood flow to the prostate. With reduced blood flow, the prostate shrinks and symptoms are relieved. 

PAE is an outpatient procedure that requires no anesthesia. It has a high success rate (75-95%), a faster recovery, fewer complications and a lower risk of sexual side effects, such as erectile dysfunction and retrograde ejaculation. Medium- and long-term results show that PAE achieved clinical success rates of 81.9% and 76.3% respectively, with no urinary incontinence or sexual dysfunction reported.

PAE is recommended for patients who:

• Have an enlarged prostate gland (>50g)
• Have failed conventional medical therapy
• Do not wish to have surgery
• Have refractory hematuria
• Have chronic kidney disease
• Are at a higher risk of surgical complications

PAE is an innovation that has come along at exactly the right time. The number of Americans over 80 years of age is projected to double over the next decade. Additionally, at just 1/3 the cost of the TURP procedure, PAE can save the American medical system tens of millions of dollars every year.

Contributed by:
Aaron Baxter, MD, FRCPC
Vascular and Interventional Radiologist
Synergy Radiology Associates

References:

1. Barry M, Roehrborn C. Management of benign prostatic hyperplasia. Annu Rev Med. 1997;48:77-189
2. Bertaccini, A., Vassallo, F., Martino, F., Luzzi, L., Rossetti, S., Di Silverio, F., et. Al. Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH. Eur Urol. 2001;40 (Suppl 1):16.
3. Cardiovasc Intervent Radiol. 2017 Nov;40(11):1694-1697. doi: 10.1007/s00270-017-1700-7. Epub 2017 May 30.