What is a Prostatic Artery Embolization!
Prostatic artery embolization (PAE) is a minimally invasive treatment to block the arteries feeding the prostate which helps improve lower urinary tract symptoms caused by a Benign Prostatic Hyperplasia (BPH). BPH is a noncancerous enlargement of the prostate gland and is the most common benign tumor that males areprone to develop.
The PAE procedure is performed by an interventional radiologist (IR), a doctor who uses and other advanced imaging to see inside the body and treat conditions without surgery.
Why Prostatic Artery Embolization?
As the prostate gets bigger, it may constrict or partly block the urethra, causing lower urinary tract symptoms such as:
• Urinary incontinence, which can range from some leaking to complete loss of bladder control
• Irritative voiding symptoms
• Increased urinary frequency, urgency, and pain upon urination
For some patients, these symptoms interfere with their quality of life
Who is Prostatic Artery Embolization Right for?
The PAE procedure is for candidates who are either ineligible or not interested in traditional surgery. An examination with an interventional radiologist can determine if you are a candidate for PAE.
What Happens During Prostatic Artery Embolization?
• PAE is performed through a small catheter inserted into the artery in the groin.
The interventional radiologist will then guide the catheter into the vessels that supply blood to your prostate.
• An arteriogram is done to map the blood vessels feeding your prostate.
• Tiny round calibrated microspheres (particles) are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply.
• The interventional radiologist will move the catheter in order to treat the other side of your prostate, repeating the steps above.
• Following this procedure the prostate will begin to shrink, relieving and improving symptoms usually within days of the procedure.
What are the risks of Prostatic Artery Embolization?
There are a few rarely occurring risk after the prostate artery embolization procedure is performed.
Most risk is posed if the blocking particles are releasedinto an artery that connects to the rectum or the bladder which could result indamage in these organs.To minimize this risk, the doctors often use advanced imaging techniques which lets them see CT images of the placement of the catheter to determine if thecatheter will release the blocking particles in the requiredartery. We need to bevastly trained and have a
good amount of experience in performing embolization.!am further assisted by a well-trained staff as well as
the disposal of the latest inmedical diagnostic and interventional procedure technology.
What are the results of controlled randomized trials?
Since we began investigating PAE and its effects on benign prostatic hyperplasia (BPH) in 2011, more than
100 peer-reviewed articles have been published. At least three randomized controlled trials (RCTs) from three different continents have found that improvements in lower urinary tract symptoms with PAE and transurethral resection of the prostate (TURP) are comparable.
Six-month results from the most recent RCT comparing transurethral resection of the prostate (TURP)
with PAE were presented at CIRSE 2017 by de Ocariz Garcia et al. Interestingly, their primary endpoint was Qmax, and results indicated no significant difference between PAE and TURP at 6 months. Although evidence exists for short and intermediate outcomes, Pisco et al published the largest long-term experience in more than 1,000 patients with follow-up beyond 5 years.
This study demonstrated the long-term effectiveness of PAE in the treatment of lower urinary tract symptoms from BPH.
What are the benefits of a minimally invasive approach?
TURP has long been the standard treatment for lower urinary tract symptoms from BPH, but unfortunately, the procedure comes with significant side effects including impotence, incontinence, or retrograde ejaculation. Advances in technology have allowed urologists to perform less invasive surgery for BPH, but they may come with less successful clinical results than TURP (eg, laser energy, retraction clips, and "steam ablation"), while still placing the patient at risk of transurethral complications.
PAE offers an innovative and unique approach to the treatment of lower urinary tract symptoms from BPH as this is the first treatment to target the prostate from a vascular or whole glandular approach. This alternative, which can potentially mitigate the risk of transurethral procedures, cannot be understated. According to one study, more than half of men avoid treatment for BPH altogether due to their fear of complications.
How is the relationship with the urologic community?
There is no doubt that the success and growth of PAE can be threatening to the urologic community. This last and most difficult variable is unfortunately part and parcel with interventional radiology as a subspecialty. It is incumbent on interventional radiologist to work both in an integrative nature with urology, as well as an independent specialty, to offer patients minimally invasive options for their health. This can be the most challenging aspect of PAE and biggest hurdle for widespread adoption. Although interventional radiology has transformed over the past 15 years into a clinically oriented specialty, it is incumbent on interventional radiologists to lead and become key stakeholders in the treatment of conditions affecting men's health, alongside other specialties.
Our ability to advance modern health care with proven, less invasive options will allow the interventional radiology community to bring PAE into prime time.