For the last four years, doctors at the UNC Medical Center in Chapel Hill have been using an innovative, catheter-based procedure called Prostatic Artery Embolization (PAE) for the treatment of an enlarged prostate, also called benign prostatic hyperplasia, or BPH.
UNC Medical Center now performs more PAE procedures per year than all but a few hospitals in the U.S. It is also one of just a few hospitals that offers PAE to patients who are not enrolled in a clinical trial.
“The PAE procedure can take anywhere from one to three hours, depending on the location and size of the prostatic arteries,” said Dr. Ari Isaacson, a vascular interventional radiologist at UNC. “Then, most patients go home the same day.”
About half of men age 50 and older have problems with urination because of BPH. That percentage increases to 80 or 90 percent in men older than 70.
In men with BPH, the prostate becomes enlarged, resulting in urinary problems such as difficulty in starting, weak flow or the need to frequently go.
Until recently, treatments for BPH were limited to medications such as alpha blockers (Flomax or Hytrin), 5-Alpha reductase inhibitors (Avodart or Proscar), or surgical procedures such as transurethral resection of the prostate (TURP). In TURP, a surgical instrument is inserted into the penis and then used to trim and remove excess prostate tissue.
There are pros and cons to both medical and surgical approaches. Medications can help relieve symptoms and reduce the size of the prostate. But they often have side-effects that affect quality of life and the benefits of the medications only last if the patient takes them continuously.
In comparison, TURP surgery improves symptoms more quickly and the improvements are longer lasting. However, in some cases, a man’s prostate is too large to be removed through a TURP procedure. TURP also carries a risk of sexual side effects such as erectile dysfunction or retrograde ejaculation (the ejaculation of semen into the bladder instead of out through the penis).
PAE’s Non-Surgical Approach
PAE is performed through a small puncture in the groin or the arm. A catheter is inserted through the artery and directed toward the prostate. Once the catheter is positioned in the artery supplying blood to the prostate, tiny particles called microspheres are injected that plug up the artery, blocking blood flow in a procedure called embolization.
“This process is then repeated on the other side, usually through the same original puncture,” Dr. Isaacson says.
The PAE procedure blocks the blood flow to the areas of the prostate that are most affected by BPH, causing these areas to become dead tissue. These areas of dead tissue then cause the prostate to soften, alleviating some of the pressure that is causing blockage of the urine.
Over several months, the body’s immune system reabsorbs the dead prostate tissue and replaces it with scar tissue. The scar tissue slowly contracts, resulting in shrinkage of the prostate. Over a six-month period, the prostate will shrink by 20 to 40 percent, resulting in improved and less frequent urination.
“About 75 to 80 percent of men treated with PAE experience a significant and lasting improvement,” Dr. Isaacson says.