Are you suffering from an enlarged prostate, otherwise known as BPH? You’re certainly not alone. According to the NIH, BPH affects 50% of men over the age of 50 and 90% of men aged 80 and above. While it’s not cancerous, the symptoms of BPH:
- Frequent urination, especially at night
- Weak or interrupted urine flow
- Urgency and difficulty starting urination
- Incomplete bladder emptying
can have a significant impact on a person’s daily quality of life. Without treatment, the constant strain on the bladder can lead to complications such as bladder stones and kidney damage. While traditionally there are several surgical treatments to consider, this article explores prostate artery embolization for BPH. So, let’s get started ….
What is prostate artery embolization (PAE)?
PAE is an innovative minimally invasive therapy popular with patients seeking an alternative to medications and traditional invasive surgery such as TURP. Indeed, its safety and efficacy are such that in 2023 the procedure was included in the latest version of the AUA guidelines. PAE works by limiting the flow of blood to the prostate causing it to gradually shrink and relieve troublesome urinary problems.
How does it work?
PAE is performed on an outpatient basis by an interventional radiologist negating the need for a hospital stay and the associated costs. Here’s what you can expect from the procedure:
- A local anesthetic and conscious sedation are administered to relieve any discomfort during the procedure.
- A tiny incision is made in the wrist or groin area to give access to a small catheter.
- Using advanced imaging technologies, the catheter is guided toward the arteries delivering blood to the prostate.
- Once in place, thousands of tiny particles, each about the size of a grain of sand, are injected, limiting the flow of blood and effectively starving the prostate. Each side of the prostate is treated. The process usually takes between 2 and 3 hours to complete.
- Over time, the prostate naturally shrinks and the pressure is removed from the bladder, giving relief from lower urinary symptoms.
- As the prostate reduces in size, urinary symptoms are alleviated, usually within a few weeks.
Unlike traditional surgeries such as TURP, PAE does not involve removing prostate tissue. Since there are no large incisions, it reduces the risk of infection, excessive bleeding, and prolonged catheter use. Patients can return to normal activities within a few days as opposed to several weeks and even resume sexual activity 10 days following the procedure.
Prostate artery embolization for BPH – The benefits
PAE has gained in popularity over traditional surgeries for the following reasons:
- No hospital stay- PAE is an outpatient procedure and in the majority of cases, most patients can return home the same day to continue their recovery.
- Quick symptom relief and faster recovery time – One of the most significant benefits of PAE has to be the quick relief it offers patients dealing with BPH. Most patients feel much better within 1 to 2 weeks of their procedure with ongoing improvements over the following 5 to 6 months.
- Lower risk of complications – According to Johns Hopkins Medicine The PAE procedure has less risk of sexual complications (retrograde ejaculation or erectile dysfunction) and urinary incontinence, when compared with more invasive surgical procedures such as TURP.
- Suitable for most prostate sizes – Due to health concerns associated with traditional surgeries and limitations to prostate size, many BPH patients are not eligible for TURP or Urolift treatments. On the contrary, PAE is a viable option for men with larger prostates since there is no size limitation. One study reported a 32% reduction in prostate volume and, at the three-month follow-up period, a decrease in IPSS (International Prostate Symptom Score) of 85.2%.
- Preserves sexual function - Another reason for the popularity of PAE compared to traditional surgeries is its ability to preserve sexual functionality – a concern for most patients undergoing regular BPH treatments. Due to its minimally invasive nature, PAE lowers the risk of nerve damage that can result in sexual dysfunction or retrograde ejaculation.
- Long-lasting relief - Several studies have reported long-lasting relief following PAE. That said, while most patients experience long-term relief, there is a 20% recurrence rate within 5 years and a 30% to 60% recurrence rate within 10 years. However, this may be attributed to the natural growth of the prostate gland. Fortunately, these patients can safely undergo a repeat PAR procedure or opt for surgical intervention.
Who is a good candidate for PAE?
Prostate embolization is potentially suitable for men who:
- Have not responded well to medication
- Have a higher risk of surgical complications
- Have medium to severe BPH symptoms
- Want to avoid surgery and long recovery periods
- Prefer a minimally invasive outpatient treatment over conventional surgery
Unfortunately, PAE is not suitable for everyone. You may not qualify for the procedure if you have:
- A history of bleeding disorders
- Severe arterial disease, which could obstruct catheter access
- An active urinary tract infection
- Severe kidney disease
- Prostate cancer
It’s essential to reveal any pre-existing conditions and discuss your medical history with your healthcare provider to learn if PAE could be a suitable treatment for you.
Prostate artery embolization for BPH – How successful is it really?
Most men who undergo PAE for an enlarged prostate report a significant improvement in their quality of life. According to one study in the Journal of Vascular and Intervention Radiology involving 630 patients with symptomatic BPH, PAE significantly reduced prostate size and improved quality of life. The clinical success rates for the medium-term (1-3 years) were 81.9% and for the long-term, the rates were 76.3%.
- No urinary incontinence or sexual dysfunction was reported
- Fewer than 1% experienced serious complications
Does insurance cover PAE?
Most private insurances cover PAE although coverage varies. PAE is also covered by Medicare.
Take the next step
If you’re struggling with BPH symptoms and looking for a safe, effective, and non-surgical treatment, Prostate Artery Embolization may be right for you. At Mint STL, our expert team specializes in advanced, minimally invasive treatments designed to improve your quality of life. Contact us today to schedule a consultation.
