April 24, 2024
Prostatic Artery Embolization

Prostatic Artery Embolization: A Safe and Effective Treatment for Benign Prostatic Hyperplasia

What is Prostatic Artery Embolization?

Prostatic artery embolization (PAE) is a minimally invasive procedure used to treat benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. During PAE, interventional radiologists thread a thin catheter through the femoral artery in the groin and guide it up into the prostatic arteries that directly supply blood to the prostate gland. Small particles are then injected into these arteries, blocking the blood flow. By restricting the blood supply to the prostate, the procedure causes the prostate tissue to shrink, relieving symptoms of BPH like frequent urination, weak urine stream, and inability to completely empty the bladder.

How is it Performed?

PAE is usually performed as an outpatient procedure under local anesthesia. Patients are given medication to help relax and sedate them during the procedure. After cleaning and numbing the groin area, the interventional radiologist makes a small nick in the skin and inserts a thin catheter into the femoral artery. Guided by real-time imaging like fluoroscopy, the catheter is maneuvered up through the blood vessels until its tip is positioned in the prostatic arteries. Very small gelatin or plastic beads called embolic agents are then injected into the arteries through the catheter. These particles act to block blood flow to the gland, causing it to shrink. The entire procedure takes about an hour. Patients can usually return home the same day.

Is it an Effective Treatment for BPH?

Numerous clinical studies have shown Prostatic Artery Embolization to be an effective treatment for BPH symptoms. In one trial evaluating the 3-year success rate of the procedure, 84% of patients saw an improvement of their symptom score by 50% or more. On average, prostate volume decreased by 25-30% within 3 to 6 months after PAE. This shrinkage helps relieve pressure on the urethra caused by an enlarged prostate, improving urine flow. PAE has also been shown to reduce reliance on BPH medications over time. In fact, clinical studies report that only about 20% of men require medications post-procedure compared to 80% pre-procedure. The improvements in urinary symptoms provided by PAE are comparable to other standard BPH treatments.

Are there any Risks or Complications?

Like any medical procedure, PAE does carry some risks. However, studies show the complication rate of PAE is low at 5-10%. Minor early side effects may include bruising or soreness at the groin puncture site, hematoma, or temporary erectile dysfunction. Rare but possible major complications include infection, recurrent bleeding requiring transfusion, trauma to the blood vessels, and non-target embolization. There is also a small risk the prostate does not shrink sufficiently or symptoms return over time. Interventional radiologists undergo extensive specialized training to perform PAE, helping minimize potential complications. The benefits of PAE usually outweigh risks for appropriate candidates.

How does it Compare to other BPH Treatments?

PAE provides an alternative to more invasive options like transurethral resection of the prostate (TURP) and other surgical treatments for BPH. Compared to TURP, PAE allows for rapid recovery without catheterization or hospital stay. Studies show PAE produces prostate size and symptom reduction similar to TURP with less risk of side effects like urinary incontinence or sexual dysfunction. Recovery is also faster with most people returning to normal activities within a few days. Lasers, microwave therapy and high-intensity focused ultrasound (HIFU) are other minimally invasive options. But PAE has shown non-inferior results while avoiding the costs and complexities of additional equipment needed with these therapies. For high-risk surgical candidates, PAE provides an effective treatment for BPH symptoms where other options may not be suitable.

Who are Candidates for PAE?

In general, PAE is offered to men aged 50 and older with bothersome lower urinary tract symptoms due to BPH. The best candidates typically have enlarged prostates 30cc or larger. Other ideal characteristics include moderate to severe LUTS as measured on the IPSS symptom scale, failure of drug therapy to provide relief, and no prior prostate surgery. Men with urinary retention requiring catheterization may also be candidates. Interventional radiologists evaluate each patient’s individual case to determine if they are a suitable candidate for PAE. The procedure is not recommended for men with known prostate cancer at this time, though research is ongoing in this area.

Outlook and Future Directions

Since receiving FDA approval in the U.S. in 2015, PAE has emerged as a safe and clinically effective option for treating BPH symptoms. Ongoing, large scale studies continue to demonstrate high success rates for relieving LUTS and reducing the need for ongoing BPH medications. PAE also appears to preserve sexual function better than alternative treatments. Refinements to catheter and embolization techniques will help optimize outcomes. Researchers are also exploring expanding the role of PAE, such as using it prior to or in conjunction with prostate cancer treatments. Overall, prostatic artery embolization holds great promise as the go-to minimally invasive therapy for symptomatic BPH, avoiding surgery for many men

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it