Prostatic artery embolization (PAE) 23 Aug,2019
Dr. Kabalan Yammine

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.