Prostatic Artery Embolization for BPH: Some Words of Caution

What happens to a man’s prostate gland when he hits middle age? If he’s lucky – and most men are – not much changes. However, millions of men will develop urinary problems as a result of the most common prostate disorder: benign prostatic hyperplasia, or BPH.

What is BPH?

BPH is a noncancerous enlargement of the prostate gland. It is not life-threatening, and many men don’t even know they have it until they go for an annual exam. A digital rectal exam (DRE) of the prostate may reveal that the gland is larger than normal. BPH can also cause a rise in PSA, so the doctor may want to rule out prostate cancer.

When the gland enlarges, it begins to narrow the urethra (the passage through the prostate that carries urine from the bladder toward the penis). This narrowing, or constriction, can cause urinary symptoms: difficulty urinating, urge to urinate more frequently, weak stream, inability to empty the bladder completely, getting up at night to urinate, etc.

If symptoms become severe enough to reduce quality of life, many men seek treatment, starting with medication. However, if medication doesn’t work, there are several types of procedures to widen the urethra. One of these is called prostatic artery embolization (PAE).

What is PAE?

The term  embolization comes from a Greek word, embolus, that means a clot or plug in a blood vessel. If you have ever heard the word embolism it meant a blockage in a vein or artery. Embolisms are dangerous since certain types can lead to death. However, in the case of BPH, embolization is a strategic blockage of blood vessels that “feed” the excessive growth of the prostate gland. When the extra tissue does not get enough oxygen and nutrients, it gradually shrinks, leading to a widening of the urethra. In turn, this alleviates the urinary difficulties.

Thus, prostatic artery embolization is a procedure to intentionally decrease the flow of blood to the enlarged prostate by blocking specific arteries.

How is PAE done?

PAE is an outpatient surgical procedure that involves injecting very small beads (microspheres) into small prostate blood vessels. The beads are placed using a flexible hollow tube called a catheter that is threaded to their target through an artery in the upper thigh.  When done correctly, PAE has a good safety record. However, side effects can occur due to inflammation or misplaced beads.

A word of caution

Since the procedure was first developed in 2009 (use in the U.S. began in 2011) studies have shown that when done correctly, the procedure is safe. However, the Sperling Prostate Center echoes many of the concerns and cautions that experts have pointed out. These include:

  • Need for accurate image guidance – the procedure is performed by an interventional radiologist under CT scanning. This requires expert knowledge of anatomy since placing the beads in the wrong blood vessel can cause serious harm.
  • Exposure to radiation – CT scans involve some exposure to radiation. It’s important that the doctor performing the procedure be experienced in order to be efficient, and minimize exposure to radiation.
  • Lack of long term data – clinical trials are ongoing to determine the effects of PAE over time. Given that the procedure itself is less than 10 years old, it will be a while before results of long-term, randomized controlled clinical trials are available.

Summary

PAE is one of several types of surgical procedures designed to reduce the urinary symptoms of BPH. It involves the permanent placement of microspheres into prostate blood vessels. Many doctors and patients prefer PAE to procedures that widen the urethra by inserting a device through the penis in order to widen the prostate urethra by cutting or ablating it. Such procedures often have a longer recovery period than PAE. It is important to note that all surgical procedures to ease BPH urinary problems have a risk of side effects, though in most cases they are minor and resolve quickly.

While PAE is considered promising, BPH patients who are not comfortable with the idea of using microspheres left in the body to block blood flow should discuss PAE with their doctor before making a treatment decision.

The Sperling Prostate Center uses Focal Laser Ablation (FLA) to reduce prostate size by ablating prostate volume away from the urethra. As the gland gradually shrinks in the weeks following FLA, urinary symptoms clear up. Because FLA is not done through the urethra (unlike vaporization laser procedures) there is minimal-to-no risk of urinary side effects, and no impact on sexual function. Contact the Sperling Prostate Center for more information.