How prostate artery embolization is effective in treating enlarged prostate

According to a recent study, prostate artery embolization (PAE) is an effective long-term treatment for urinary problems brought on by an enlarged prostate gland. In the longest long-term North American trial, 1,000 patients with benign prostate hyperplasia who had PAE reported considerable persistent improvement from lower urinary tract symptoms (LUTS) or urine retention for up to six years (BPH). With more than 50 per cent of men over 60 affected, BPH is the most prevalent benign disorder in men. The urethra, which conducts urine from the bladder, is compressed as the prostate gland grows larger with age. This pressure commonly results in urinary urgency, increased frequency, irregular flow, straining to urinate, and the inability to completely empty the bladder.

"Our study shows that PAE is a highly effective treatment whose long-term outcomes include sustained LUTS relief and significant improvement in quality of life," said senior author Shivank Bhatia, M.D., Chair of Interventional Radiology at the University of Miami Miller School of Medicine. "Of 18 million men in the U.S. eligible for BPH treatment, many avoid all treatments because of the widely known risks of surgery, particularly sexual side effects and leakage. PAE avoids these risks while achieving long-term positive clinical outcomes." With PAE, interventional radiologists inject tiny particles into arteries that feed the prostate gland, reducing its blood supply, thereby shrinking it. Researchers say that PAE shows "great short-term to midterm results" and positive long-term results in self-reported symptom improvement.

Participants reported dramatic improvements on the 35-point International Prostate Symptom Score, which ranks symptoms as mild, moderate or severe. Pre-procedure, patients reported a mean score of 23, in the "severe" range. But in less than three months, they achieved a score of 6, with "mild" symptoms persisting throughout the six-year study - a response similar to that following more invasive surgical options for BPH. However, PAE did not negatively impact sexual function and no incidence of leakage was reported after PAE. Study participants were also asked a quality-of-life question: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?" Pre-procedure, the mean score was 5 or "mostly dissatisfied," but within a year, the score was 1, or "mostly satisfied," a ranking that also continued throughout.

PAE has a well-established safety profile, as shown in repeated studies in the 10 years since it was first used. However, interventional radiologists say most men are unaware of this treatment option. Most will avoid surgery and may instead take medication for years, even as BPH worsens, potentially leading to bladder failure. "Patients choose PAE to avoid the side effects of current medications for BPH, which can include erectile dysfunction, painful or difficult urination, constipation, dizziness or fatigue," said the study's lead author Andrew Richardson, M.D., a senior resident at Jackson Memorial Hospital in Miami. "Prostate artery embolization is an alternative not just to surgery but also to lifelong medication."

Among the study's findings was a persistent, years-long reduction in prostate size. However, Bhatia noted that prostate size reduction is not the only goal in long-term effectiveness. "Treatment should make the prostate softer as well as smaller - as opposed to smaller but remaining hard, which will still cause urinary symptoms."