PAE Is a Promising BPH Treatment Alternative

The procedure may be particularly efficacious for men with very large prostates.
The procedure may be particularly efficacious for men with very large prostates.

AMELIA ISLAND, FL—Prostate artery embolization (PAE) has been emerging as a minimally invasive alternative for patients suffering from benign prostatic hyperplasia (BPH).  Via femoral or radial artery access, an interventional radiologist deploys microspheres endovascularly to block the arterial supply to the prostate using a small diameter micro catheter. With blood supply curbed, the prostate shrinks in size, relieving the symptoms of BPH such as slow or weak urinary stream, urgency and frequent urination.

Shivank Bhatia, MD, Associate Professor of Interventional Radiology and Urology at the University of Miami Miller School of Medicine, who has been at the forefront of the implementation of this procedure in United States, spoke about his 3 years of experience with PAE during a presentation at the Florida Urological Society (FUS) annual meeting. All the patients treated by Dr Bhatia are assessed in a multidisciplinary fashion with urologists, interventional and diagnostic radiologists, and primary care physicians. This multidisciplinary approach helps providers to offer all the possible treatment alternatives, including PAE when appropriate, and helps patients to make an informed decision regarding their condition, he said. “With BPH affecting so many men, having another option that is minimally invasive is a real benefit to patients,” Dr Bhatia said.

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Dr Bhatia highlighted how PAE has been able to alleviate symptoms and improve the quality of life of his patients. For example, one 80-year old patient had presented with refractory urinary retention for three months. The patient's MRI revealed a prostate volume of 571 mL, and he had declined open prostatectomy. PAE was performed and the patient was able to urinate freely within 10 days of the procedure. At 3 months follow-up, the patient's prostate volume dropped to 270 mL, his BPH symptoms were mild, and his quality of life score had improved from “terrible” to “pleased.”

Although this patient was unique in having such a large prostate, Dr Bhatia said many of the patients he has treated with PAE have similar favorable outcomes. Since first performing PAEs in 2014, Dr Bhatia has treated patients with a variety of prostate-related issues ranging from lower urinary tract symptoms and urinary retention to gross hematuria and as a pre-operative measure to reduce blood loss during radical prostatectomy for prostate cancer. The majority of the patients treated with PAE can go home a few hours after the procedure and report significant improvement in urinary function within a month of the procedure.

“PAE offers a non-invasive alternative to treatment of BPH in men who are refractory to medical therapy,” said Sanoj Punnen, MD, attending urologist at the University of Miami and the FUS program co-chair. “For many men who may find the surgical options to be less appealing, this technology provides them with a safe and effective alternative to standard therapies.”

Dr Shivank Bhatia

Shivank Bhatia, MD, is associate professor of Interventional Radiology and Urology at the University of Miami Miller School of Medicine.

Program co-chair Christopher S. Gomez, MD, a BPH specialist, works closely with Dr Bhatia to offer a multidisciplinary approach to patients suffering with BPH. “PAE has emerged as a minimally invasive treatment option for men that I routinely discuss when counseling them regarding surgical alternatives to TURP,” Dr. Gomez said.

When compared with surgical options like TURP, PAE has a vastly diminished risk of long-term side effects, such as retrograde ejaculation, incontinence, or sexual dysfunction, Dr Bhatia explained. Post-procedural adverse effects of PAE most commonly include urethral burning and urinary frequency. Within 2 weeks of the procedure, however, these effects usually resolve.

PAE seems to have a role in a select cohort of patients, Dr Bhatia pointed out. Specifically, PAE could be an option for elderly patients who have an increased risk of morbidity with conventional surgery. PAE may be most beneficial in patients with larger prostates. Dr Bhatia said he plans to continue performing PAEs and examine its long-term efficacy. Randomized controlled studies comparing PAE versus TURP are still in progress.

“These studies will enable us to introduce an alternative treatment option for the patients with an enlarged symptomatic prostate,” Dr Bhatia said. “PAE needs to be studied in more detail before it can be adopted as an approved mainstream alternative for management of BPH; however, initial results are very encouraging. This treatment alternative might have niche applications in patients with very enlarged glands.”

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