Non-Surgical Prostate Enlargement Treatment: A Permanent Solution with Prostate Artery Embolisation
Dear readers, I am Prof. Dr. Aykut Recep Aktaş. My specialisation is Interventional Radiology, and my aim is to improve our patients' quality of life using the least invasive and most effective treatment methods that modern medicine offers. In this article, we will comprehensively discuss Prostate Artery Embolisation (PAE), one of the non-surgical treatment options for benign prostatic hyperplasia (BPH), a common condition experienced by men in later life. I wish to explicitly state that I am not a Urology specialist, and this treatment approach falls within the expertise of Interventional Radiology.
What is Benign Prostatic Hyperplasia (BPH) and Why Should it Be Treated?
The prostate is a small gland located below the bladder in men, surrounding the urethra. Benign enlargement of this gland (BPH) is a very common condition with age. The enlarged prostate presses on the urethra, leading to various urinary problems. Symptoms such as frequent urination, waking up at night to urinate, difficulty urinating, interrupted urine flow, decreased urine stream, and the sensation of incomplete bladder emptying can significantly reduce quality of life. If left untreated, it can lead to more serious complications like urinary tract infections, bladder stones, or kidney problems.
How Does Prostate Artery Embolisation (PAE) Work?
Prostate Artery Embolisation is a minimally invasive Interventional Radiology procedure developed for patients with symptoms related to benign prostatic enlargement. During this procedure, there's no need for general anaesthesia; it's typically performed under local anaesthesia. A thin catheter is inserted into a small blood vessel, usually in the groin (femoral artery) or sometimes the wrist (radial artery). Under angiographic guidance, the arteries supplying blood to the prostate (prostatic arteries) are located. Very small, biocompatible particles (embolic agents) are then injected into these vessels to slow down or stop the blood flow. As the blood supply to the prostate decreases, it gradually shrinks, reducing pressure on the urethra and leading to significant improvement in symptoms.
Effectiveness and Benefits of PAE
Prostate Artery Embolisation is a treatment with proven efficacy in numerous clinical studies. The vast majority of patients (typically 70-90%) experience significant improvement in urinary symptoms and an enhanced quality of life. Post-procedure, a 20-50% reduction in prostate volume and an increase in urine flow rate have been reported. This improvement is generally permanent, and long-term results are promising. Among the most significant benefits of PAE are the absence of a surgical incision, no requirement for general anaesthesia, a short hospital stay (often same-day discharge), no negative impact on sexual function, and a reduced need for catheterisation.
Risks and Potential Side Effects of PAE
As with any medical procedure, PAE carries certain risks, though these are generally much lower compared to surgical interventions. The most common side effects include mild groin pain after the procedure, burning sensation during urination, or blood in the urine or semen. These symptoms are usually temporary and resolve on their own within a few days. While rarer, risks such as urinary tract infection, temporary urinary retention (inability to urinate), or the migration of embolic particles to non-target vessels can occur. When performed by an experienced Interventional Radiologist, these risks are minimised, and the rates of serious complications are very low.
Differences Between PAE and Surgical Treatments
Traditionally, surgical methods such as transurethral resection of the prostate (TURP), laser surgery, or open prostatectomy have been used to treat BPH. PAE offers significant differences and advantages compared to these surgical options:
- Minimally Invasive: PAE does not require a surgical incision. Access to the blood vessel is achieved through only a small needle puncture. Surgical methods, however, involve entering through the urethra or open surgery to remove prostate tissue.
- Anaesthesia: PAE is typically performed under local anaesthesia and sedation, while surgical procedures require general or spinal anaesthesia.
- Recovery Time: After PAE, patients can usually be discharged on the same day or the next, and quickly return to their daily activities. Surgical recovery time is longer, and hospital stays are generally more extended.
- Sexual Function: PAE has been shown to have no negative impact on sexual function, and in some patients, it may even lead to improvement. The risk of sexual dysfunction, such as retrograde ejaculation, is higher after surgery.
- Bleeding Risk: The risk of bleeding with PAE is significantly lower compared to surgery.
- Catheter Use: After PAE, there is usually no need for a urinary catheter, or it is required for a very short period. Catheter use after surgery is more common and prolonged.
Who is a Suitable Candidate for Prostate Artery Embolisation?
Prostate Artery Embolisation is a suitable option for patients who haven't responded to medication, cannot tolerate medication side effects, are unsuitable for surgery (due to advanced age, heart disease, or other comorbidities), or wish to avoid surgical risks. Furthermore, patients who want to preserve their sexual function or are dependent on a catheter can also be good candidates for PAE. Each patient's condition must be assessed individually, and suitability determined by an Interventional Radiologist after a detailed examination and imaging (such as MRI).
Post-Procedure Period and Follow-Up
Following PAE, patients are typically discharged after a few hours of observation. For the first few days, mild pain and a burning sensation during urination may occur and can be managed with painkillers. Significant improvement in urinary symptoms usually begins within the first few weeks and reaches maximum effect within 3-6 months. Regular follow-up appointments are conducted after the procedure to monitor the reduction in prostate volume and the improvement in symptoms. For our robotic technologies in interventional radiology, you may wish to visit our prostate biopsy page.
Conclusion
In the treatment of benign prostatic hyperplasia, Prostate Artery Embolisation (PAE) is a safe and effective minimally invasive Interventional Radiology method, offering an excellent alternative to surgery. With advantages such as lower risks, faster recovery, and preservation of sexual function, it has the potential to significantly improve the quality of life for suitable patients. If you are experiencing symptoms of an enlarged prostate, discussing this non-surgical treatment option with an expert Interventional Radiologist will help you chart the most appropriate course of action tailored to your needs. Remember, the right treatment option is delivered by the right specialist.