Prostatic artery embolization, a new interventional radiology treatment, may bring hope to men with debilitating symptoms caused by an enlarged prostate, say the group of researchers who pioneered its use.
“Having an enlarged prostate is very common in many men over the age of 50, and these new findings provide hope for those who might not be candidates for transurethral resection of the prostate, or TURP–and may allow them to avoid serious complications that sometime result from surgery, such as impotence, retrograde ejaculation and urinary incontinence. This could mean that more men have a chance at getting their lives back,” said Francisco Cesar Carnevale, M.D. Ph.D., professor and chief of the interventional radiology section at the Hospital das Clinicas Hospital of the Faculty of Medicine at the University of Sao Paulo in Brazil.
With age, a man’s prostate can grow larger due to a noncancerous process called benign prostatic hyperplasia, or BPH. This enlargement can compress the urethra and cause urination and bladder problems. For these men, symptoms can cause a marked decrease in quality of life, said Carnevale.
According to Carnevale, “Interventional radiologists have always pioneered the use of minimally invasive treatments for many disease states. Interventional radiologists have used embolization, where a catheter is used to deliver tiny beads to block blood flow to a target area, for many years to treat uterine fibroids, on an outpatient basis, with very few complications. Applying this same principal to the prostate by embolizing or blocking the prostatic arteries, thereby reducing its size and releasing the pressure on the urethra so that a man is then able to void normally, seemed like a natural progression.”
“This study looked at results from men who suffered with acute urinary retention due to an enlarged prostate and who were treated,” noted Carnevale, who indicated that prior to embolization, all had medical treatment and urethral catheters and were waiting for surgery. “After the treatment, we assessed quality of life and evaluated how well the urinary system was working. Clinical success was seen in 91 percent of those treated and technical success was evident in 75 percent of those treated,” he added.
Using a tiny one-millimeter diameter microcatheter threaded into the prostate arteries, 12 prostatic artery embolization procedures using resin microspheres as embolizing agents were performed on 11 individuals (ages 59-78 years; average age, 68.5 years) under local anesthesia. Magnetic resonance imaging and ultrasound were also used to study the exact anatomy of the prostate.
“Although these preliminary results are very promising for American men, it must be noted that prostate artery embolization is an extremely advanced embolization procedure requiring rigorous training and a detailed knowledge of the prostate anatomy and surrounding vessels,” said James B. Spies, M.D., MPH, FSIR, professor and chair of the radiology department at Georgetown University Medical Center in Washington, D.C. “Because interventional radiologists are the leaders in bringing forth new treatments responsibly, I expect there will be considerable additional study, including multicenter clinical trials, that explore the safety, efficacy and durability of this procedure before it will become broadly available in clinical practice. At that stage, the specialty will take the lead on ensuring that practice guidelines are established to ensure appropriate patient care,” he added.