BPH is benign enlargement of the prostate gland. This is not the same as prostate cancer. BPH is a common condition, affecting ⅓ of men over 50 and 60% of men over 60.
The prostate gland is a small organ surrounding the urethra, the tube carrying urine from the bladder to the penis. Enlargement of the prostate is one cause of lower urinary tract symptoms (LUTS) –
- Urinary frequency – having to pass urine more often than normal
- Poor flow – where the stream is weak or interrupted
- Poor emptying – causing need to go again as well as dribbling/feeling of fullness after emptying
- Nocturia – having to get up in the night
- Urge – the need to rush to the bathroom to avoid leaking
How is BPH/LUTS managed?
The first line treatment option is medical management. This can be effective but unfortunately is limited in most men by either cardiovascular side effects (dizziness, fainting) or sexual dysfunction (impotence, reduced libido).
The current gold-standard next line treatment is currently TURP – where a large tube inserted via the penis is used to core away the inside of the prostate. Whilst this does improve symptoms it comes with surgical risk and is strongly associated with impotence, incontinence and retrograde ejaculation (failure to ejaculate on orgasm).
Other urological treatment options come with similar invasive nature and risks (Laser/greenlight) or are less well established and still require entry via the penis (urolift).
Undoubtedly symptoms are best managed by an individual patient-centred approach and some men would be best served by surgery and others by PAE or other options. When you are seen in rooms by the IR specialist you can trust that you will be only offered treatment if it is thought to be your best option.
Initial patient enquiries are welcome. Send us an email or call and we will email a patient information form for you to complete.
Ask your GP to refer you for a consult. Note that consultations without a referral cannot be claimed from Medicare.
After listening to your symptoms and taking a medical history we will discuss further investigations or scans needed to establish whether PAE is an option for you.
This will be discussed at time of consult but may include:
- Renal tract/bladder ultrasound
- Urine flow study
- PSA blood test
Should PAE be a suitable treatment option for your symptoms then further scans required may include:
- CT angiogram (a specialised CT to evaluate the blood vessels supplying the prostate)
- MRI prostate (this is done as a baseline to allow comparison after treatment as well as to exclude the possibility of any cancer in the prostate
Prostate cancer in the early stages often does not cause symptoms. Identification and follow up of prostate cancer is based on appearances at MRI. The PAE treatment could affect these appearances. This is therefore an opportunity to ensure you do not have any identifiable cancer within the prostate prior to treatment.
The treatment can last 2-3 hours. During this time you will receive medication (sedation and analgesia) to relax you and keep you comfortable. Often the treatment passes more quickly than patients realise.
Unlike some other treatment options PAE is done using sedation and local anaesthetic. The procedure is not painful although you may feel some minor normal burning sensation at intervals during the treatment. This means PAE can be offered to men who, because of other medical problems, cannot have the anaesthetic required for more invasive treatments.
Tiny particles are used to block the blood supply to the prostate. This is done using a tiny tube inserted via the wrist (or groin). X-rays are used to guide the specialist (interventional radiologist) into the prostate arteries. This is a complex and difficult procedure performed by a specialist interventional radiologist expert in this area.
You will stay for up to 2 hours after the treatment. There is no need to stay overnight.
Unlike some invasive treatments for LUTS a catheter is not required for PAE.
You will have to avoid exercise, heavy lifting etc for 2-3 days, this includes avoiding intercourse.
You may feel tired for a few days afterward. Some burning pain when passing urine is common. These symptoms usually settle within a week or so.
You will receive a prescription for antibiotics and be advised to take painkillers and antiinflammatories following the treatment.
PAE is an excellent option if your symptoms are poorly controlled on medication but you do not want surgery.
It is suitable for men who because of other medical conditions are ‘high risk’ for more invasive treatments.
It is suitable for men who take antiplatelets or blood thinners/anticoagulants as the risk of bleeding is much less than for invasive treatments.
PAE is suitable for men with very large prostates, for whom we know surgical options are less safe or effective.
PAE is suitable for men with a permanent urinary catheter who have been told there are no other options. There are many examples of men who have successfully been able to remove their catheters following PAE.
PAE is suitable for men who are sexually active as evidence shows it preserves (and may be associated with improved) sexual function. PAE does not cause the retrograde ejaculation (failure to ejaculate) which is almost always seen in TURP.
PAE has been researched in Europe, the USA, Brazil, China and Australia. Randomised controlled trials show symptom improvements comparable to TURP with fewer side effects.
The UK-ROPE registry (a database of real-world patients undergoing treatment in many centres) again showed similar results to TURP with less severe side effects.
The UK National Institute for Healthcare and Clinical Excellence (NICE) recommended PAE alongside TURP as a treatment option for men who did not improve with medication.
PAE is safe and very low risk when compared with surgical alternatives and does not cause the incontinence and sexual dysfunction associated with invasive treatment options. The evidence, however, shows that some men do not respond as well as would be hoped to the treatment. The good news is that a repeat procedure often helps and PAE does not prevent more invasive treatment options.
We also know that the degree of symptom improvement (as measured by symptom scores and urine flow rate) with PAE is not quite as good as TURP but the symptom improvement achieved is almost always significant and comes without the invasive nature of TURP/laser, the risk of surgical complications or the incontinence and sexual dysfunction seen with these treatments.
No. Some men with urinary tract symptoms may have an enlarged prostate without this being the main cause of their symptoms. Men with associated problems such as bladder stones or predominantly night time symptoms (nocturia) may not be suitable. Furthermore, men with ‘mild’ symptoms (assessed at time of consult in rooms) are currently considered best treated by medication.
Men who wish definitive symptom improvement regardless of side effects and who are not concerned about sexual function are well served by TURP/laser. Sexually active men who wish a safer, less painful and less invasive treatment option with quicker recovery should consider PAE. Men unsuitable for TURP are almost always able to be treated safely by PAE.