Prostate Artery Embolization [PAE] is a minimally invasive procedure for men who have severe symptoms of benign prostatic hyperplasia [BPH] and who have failed conservative and medical treatment. It is a same-day procedure that involves placing a catheter directly into the prostate artery and injecting tiny beads to shrink a prostate of any size. The advantage of PAE over surgery is that it does not cause incontinence, bloody urine, or loss of sexual function, unlike surgery.
BPH is common in men as they age, and a non-cancer growth of the prostate that potentially blocks or reduces the flow of urine.
Patients present with difficulty urinating and controlling the bladder. Severe cases can lead to repeated infections or dysfunction of the kidney or bladder.
What Investigations for a Prostate Artery Embolization [PAE]?
For an initial evaluation, history is obtained, a physical exam and a digital rectal exam are performed. The symptom severity, quality of life, erection, and sexual function are scored. Laboratory, imaging, and urine flow examinations are ordered.
What is the evidence for Prostate Artery Embolization [PAE]?
Prostate Artery Embolization is approved for the treatment of obstructive symptoms of BPH by the Food and Drug Administration [FDA] and the National Institute for health and care excellence [NICE].
Prostate Artery Embolization PAE has long been known as an effective treatment for uncontrollable bloody urine (refractory hematuria) due to BPH or prostate cancer. Since 2008, Investigators like Dr. Canavale and Dr. Pisco started evaluating the use of Prostate Artery Embolization for the treatment of obstructive symptoms of BPH. Since then many studies have shown that PAE is safe and effective with 80-90% success with respect to improving urine flow, quality of life, and erectile function.
Is Prostate Artery Embolization used for Prostate Cancer?
There is ongoing research evaluating the effectiveness of Prostate Artery Embolization with chemotherapeutic loaded beads for the adjunctive treatment of prostate cancer. This approach has been used successfully in the liver and preliminary results for use in prostate cancer are encouraging. The current treatments for prostate cancer will be discussed in another blog.
Who performs Prostate Artery Embolization PAE?
Prostate Artery Embolization should be performed by a Vascular and Interventional Radiologist who has special training because of the very complex blood supply of the prostate. In my personal experience with PAE, the results have been very encouraging. I started performing PAE in 2013 and at the time it was still considered experimental. The first patient in whom I performed prostate artery embolization called 2 weeks post-procedure to tell me about the remarkable change in his urine flow and his sexual function and that he felt 25 years younger. My most rewarding PAE cases are for patients with giant prostates who were catheter dependent These patients suffered repeated hospitalization due to urinary tract infections and were high-risk for prostate surgery. After performing PAE on these patients, most were able to remove the catheters in 2 weeks.
How do I perform Prostate Artery Embolization?
I perform Prostate Artery Embolization [PAE] in the Angiography suite with local anesthesia and conscious sedation. There is no cutting involved in the PAE procedure. After patients are prepped in the pre-procedure area, they are transported to the Angiography Suite and placed on their back. Conscious sedation is initiated by the sedation nurse under my direct supervision with continuous monitoring of vital signs. I use the left wrist approach or the groin approach depending on a patient’s body habitus or preference. The patient is sterilely cleaned and draped. I numb up the skin of the wrist with local anesthetic and I puncture the artery with a tiny needle using ultrasound for guidance. After a series of exchanges, I navigate a tiny catheter directly to the prostate artery and I inject dye to see the large prostate. I inject tiny beads to block the blood flow to the prostate, in the embolization step.
After a 2 hour observation, patients are discharged home on antibiotics and anti-inflammatory medicines. The end result is that the prostate tissue is devitalized, and the pressure on the urethra and the ejaculatory duct is relieved. The prostate shrinks and good urine flow and ejaculation are established at about 2 weeks.
What is Follow up after Prostate Artery Embolization
Patients are advised to restrict activity for 2-3 days. Patients who had the procedure to stop hematuria (bloody urine) will have control of bleeding within 24 hours after the PAE procedure. Patients with longstanding bladder catheters can attempt removal at 15 days. Typically, improved urine flow is achieved at 2 weeks. Studies show that symptom score and urine flow at 12 months and 2 years are similar to transurethral resection of prostate [TURP] and prostatectomy.
Conclusion
Prostate Artery Embolization [PAE] is ideal for patients seeking a minimally invasive procedure for the treatment of obstructive symptoms of BPH. PAE establishes adequate urine flows and preserves sexual function with no complications of urine leak. This option should be discussed with a patient when contemplating surgery for obstructive symptoms due to very large prostates.
