A common condition among most aging men is benign prostatic hyperplasia (BPH), a noncancerous condition where the prostate becomes enlarged and urinary issues start to take hold. BPH can have a deeply negative impact on a man’s quality of life, leaving him searching for relief. Symptoms include urinary urgency, frequent urination, straining to urinate, urinating multiple times in the night, incomplete emptying of the bladder, and sometimes sexual side effects.

Why does this Become a Problem?

When the prostate becomes enlarged, pressure is placed on the urethra, and a man cannot urinate properly or efficiently. The goal of treatment is to remove this pressure.

Traditional treatment of BPH involves medication as well as several procedural options, some of which require surgery, an inpatient hospital stay, and the potential for unpleasant side effects. Additionally, a patient must meet certain requirements to qualify.

prostate artery embolization

There is a different way – a minimally invasive approach with relatively few side effects that does not involve burning or removing the prostate. Introduced more widely within the past 10 years, prostate artery embolization (PAE) has grown in popularity due to the benefits and its success rate. The patient receives moderate sedation, so general anesthesia is not necessary, and the procedure takes anywhere from one and a half to three hours. Ravi Dalal, MD, board-certified interventional and vascular radiologist with Raleigh Radiology explains, “The idea is that if we shrink the prostate by getting rid of the blood supply on both sides, it will have the same effect as other treatments, but it is safer. With-out a blood supply, nutrients can’t reach the prostate, and the cells will die. The body’s immune system will then remove the cells and create scar tissue. The prostate will shrink, and the tissue around the urethra will open up, allowing urine to flow freely and reducing many symptoms.”

Performed in the hospital, PAE is a technical procedure that requires precision and expertise one would get through an interventional radiology fellowship. The radiologist may perform the procedure trans-radially (through the patient’s wrist) or through the groin. Either option creates no more than a 2 mm incision and requires no stitches. The radiologist then injects microscopic beads into the artery that runs to the prostate. These beads will ultimately block the blood supply. Multiple techniques are employed during the procedure to ensure the beads are inserted into the correct artery. After about two hours in recovery, the patient is sent home and prescribed antibiotics and NSAIDs to help with any inflammation or pain.

Before PAE, most men report a variety of negative symptoms that impact their quality of life using a symptom tracking score methodology known as the International Prostate Symptom Score (I-PSS) rubric. The eight-question screening tool tracks and assesses symptoms of patients with BPH by determining a man’s difficulty with urination and also helping select the best treatment options. “After a PAE, we want to see those screening scores trending in the right direction. Greater than 75% of men say they experience an improvement in symptoms after this procedure. Patients also appreciate that PAE comes with few side effects, most commonly mild pain upon urination which usually subsides within days to a few weeks,” says Dr. Dalal.

Rarely, post embolization syndrome can occur after PAE (low-grade fever, nausea, chills, discomfort when urinating), but this is temporary and resolves within a week. After the procedure, a patient should meet again with his radiologist to assess progress.

Interventional radiologists and urologists are very selective when assessing patients for PAE. It is most helpful in patients who have markedly enlarged prostates. Using a CT scan prior to the procedure, the physician maps out the prostate’s anatomy and ensures the blood vessels are healthy enough for a successful procedure. For patients where medical therapies have failed or those with pre-existing conditions where surgery is not an option, this may be a good alternative.

PAE can also help patients who have chronic indwelling foley catheters by shrinking the prostate and removing the catheter, as well as men who have hematuria, or bleeding from the prostate. By blocking the blood supply, the radiologist can use PAE to help stop the hematuria and shrink the prostate.

“Urologists prefer to avoid surgery with their high-risk patients, making PAE a good choice. The risk is less for PAE since it only requires moderate sedation and is not a surgical procedure,” explains Dr. Dalal. The radiologist will consult with your urologist to develop a multidisciplinary approach and develop the best treatment option.

“PAE takes a lot of skill and experience. Every patient is different,” reflects Dr. Dalal. “The fact that we can treat these patients with a minimally invasive approach and have such a significant impact on their symptoms is very exciting and satisfying. I’ve actually had patients tell me they feel like they are 20 years old again.”