Prostatic artery embolization
Non-surgical treatment of bening prostate hyperplasia (BPH) (Prostatic Artery Embolization) (PAE)
What is BPH, and what causes it?
BPH is a non-cancerous enlargement of the prostate gland that commonly affects men over the age of 50. The exact cause of BPH is not fully understood, but it is believed to be related to changes in hormone levels as men age, particularly an increase in levels of dihydrotestosterone (DHT). Genetics and lifestyle factors may also play a role in the development of BPH.
What are the symptoms of BPH?
The most common symptoms of BPH include:
Urinary frequency (needing to urinate more often than usual)
Urgency (sudden and urgent need to urinate)
Difficulty starting urination
Weak urine stream
Dribbling at the end of urination
Incomplete emptying of the bladder
Nocturia (frequent urination at night)
How is BPH diagnosed?
BPH is typically diagnosed through a combination of a medical history, physical exam, and diagnostic tests. These may include:
Digital rectal exam (DRE): A doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland for signs of enlargement or irregularities.
Prostate-specific antigen (PSA) test: A blood test to measure the level of PSA, a protein produced by the prostate gland that can be elevated in BPH and prostate cancer.
Urinalysis: A urine test to check for signs of infection or other abnormalities.
Imaging tests: X-rays, ultrasound, or MRI may be used to visualize the prostate gland and surrounding tissues.
What are the treatment options for BPH?
Treatment options for BPH depend on the severity of symptoms and other factors, such as age and overall health. Treatment options may include:
Watchful waiting: For mild symptoms, a doctor may recommend monitoring the condition without any active treatment.
Medications: Certain medications, such as alpha-blockers or 5-alpha-reductase inhibitors, can help relieve symptoms of BPH by relaxing the muscles in the prostate gland or reducing the production of DHT.
Minimally invasive procedures: Procedures such as transurethral resection of the prostate (TURP), transurethral needle ablation (TUNA), or prostate artery embolization (PAE) may be used to remove or destroy prostate tissue and relieve symptoms.
Surgery: In severe cases, surgery to remove part or all of the prostate gland (prostatectomy) may be necessary.
Can BPH be prevented?
There is no known way to prevent BPH, but certain lifestyle changes may help reduce the risk of developing symptoms. These may include maintaining a healthy weight, exercising regularly, avoiding alcohol and caffeine, and practicing good bladder habits (such as avoiding holding urine for long periods).
Is BPH a precursor to prostate cancer?
BPH is not a precursor to prostate cancer, but the two conditions can coexist. Men with BPH may be at an increased risk of developing prostate cancer, but having BPH does not necessarily mean that cancer will develop. It is important for men with BPH to receive regular prostate cancer screenings to detect any abnormalities early.
Can BPH cause erectile dysfunction?
While BPH itself does not directly cause erectile dysfunction (ED), the condition can sometimes contribute to ED by interfering with normal sexual function. For example, BPH-related urinary symptoms can cause discomfort or anxiety during sexual activity, which may affect erectile function. Additionally, some medications used to treat BPH (such as alpha-blockers) can cause ED as a side effect. Men with BPH who experience ED should talk to their doctor about treatment options.
Is BPH a serious condition?
While BPH itself is not life-threatening, it can cause significant discomfort and inconvenience if left untreated. Severe cases of BPH can lead to complications such as urinary tract infections, bladder stones, or kidney damage. It is important for men with BPH to seek medical attention if they experience symptoms such as difficulty urinating, blood in the urine, or urinary retention (inability to empty the bladder).
How long does it take for BPH treatment to work?
The length of time it takes for BPH treatment to work depends on the type of treatment used and the severity of symptoms. Some medications may start to relieve symptoms within a few days, while others may take several weeks to show an effect. Minimally invasive procedures may provide immediate relief, but it may take several weeks or months for full results to be seen. Patients undergoing surgery for BPH may experience a longer recovery period, with symptoms gradually improving over several weeks to months.
Can BPH be treated without surgery?
Yes, BPH can often be managed with non-surgical treatments such as medication or minimally invasive procedures. However, in severe cases or if other treatments are not effective, surgery may be necessary to remove or reduce the size of the prostate gland. Patients with BPH should discuss all treatment options with their doctor to determine the best approach for their individual needs.
What is prostatic artery embolization (PAE)?
PAE is a minimally invasive procedure used to treat the symptoms of benign prostatic hyperplasia (BPH). During the procedure, a small catheter is inserted through a small incision in the groin and guided to the arteries that supply blood to the prostate gland. Tiny particles are then injected through the catheter to block these arteries, reducing blood flow to the prostate and causing it to shrink over time.
Which tests do i need before PAE?
Prostate exam: Your doctor will perform a digital rectal exam (DRE) to check the size, shape, and consistency of your prostate gland.
Urine tests: You may need to provide a urine sample to check for signs of infection or other abnormalities.
Blood tests: Your doctor may order blood tests to check your kidney function, prostate-specific antigen (PSA) levels, and other markers of prostate health.
Imaging studies: Your doctor may order an ultrasound, MRI, or CT scan to help visualize the prostate and surrounding blood vessels, and to identify any other conditions that may be contributing to your symptoms.
Urodynamic studies: If you are experiencing urinary symptoms, your doctor may order urodynamic studies to evaluate your bladder function and urine flow.
Other tests: Depending on your medical history and symptoms, your doctor may order additional tests or consultations with other specialists, such as a cardiologist or pulmonologist, to ensure that you are healthy enough to undergo the procedure.
IPSS score: IPSS stands for International Prostate Symptom Score, which is a standardized questionnaire used to evaluate the severity of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), also known as an enlarged prostate.
The IPSS questionnaire asks about the severity of urinary symptoms such as incomplete emptying of the bladder, frequency of urination, intermittency of the urine stream, urgency, weak stream, straining during urination, and nocturia. Each symptom is scored on a scale of 0 to 5, with higher scores indicating greater severity. The scores are then added together to give a total IPSS score ranging from 0 to 35.
The IPSS can help doctors to assess the severity of a patient's urinary symptoms, monitor changes in symptoms over time, and evaluate the effectiveness of treatments for BPH.
What is multiparametric or dynamic prostate mr examination?
Multiparametric magnetic resonance imaging (mpMRI) is a type of imaging test used to evaluate the prostate gland. It combines multiple imaging sequences to provide a more detailed and comprehensive view of the prostate than traditional MRI.
The exam typically includes several different sequences, each of which highlights different aspects of the prostate tissue. These may include:
T2-weighted imaging: This sequence provides high-resolution images of the prostate gland, allowing doctors to visualize the size, shape, and texture of the gland and identify any abnormalities or lesions.
Diffusion-weighted imaging (DWI): This sequence measures the movement of water molecules within the prostate tissue, allowing doctors to differentiate between normal and abnormal tissue.
Dynamic contrast-enhanced (DCE) imaging: This sequence uses a contrast agent to highlight areas of the prostate with increased blood flow, which can be a sign of cancerous or abnormal tissue.
By combining these sequences, doctors can more accurately identify and locate abnormalities in the prostate gland, including tumors or areas of inflammation. This can help guide further diagnostic testing or treatment decisions.
mpMRI is increasingly used in the diagnosis and management of prostate cancer, as it can help to reduce the need for invasive biopsies and improve the accuracy of cancer detection. It can also be used to monitor the progression of the disease over time and guide treatment decisions.
What is mr guided fusion biopsy of prostate?
Magnetic resonance (MR) guided fusion biopsy is a type of diagnostic procedure used to identify and sample abnormal tissue within the prostate gland. It involves combining images from a magnetic resonance imaging (MRI) scan with real-time ultrasound images to precisely locate suspicious areas of the prostate gland for biopsy.
During the procedure, a radiologist or urologist will first perform an MRI scan of the prostate gland to identify any areas of abnormal tissue. The MRI images are then fused with real-time ultrasound images of the prostate, allowing the doctor to precisely target the area of concern for biopsy.
The procedure is performed under local anesthesia and typically takes about 30-60 minutes. The doctor will insert a thin needle into the prostate gland to remove a small tissue sample from the targeted area. Multiple samples may be taken, depending on the size and location of the area of concern.
MR-guided fusion biopsy offers several advantages over traditional biopsy methods. Because it uses both MRI and ultrasound images, it can help to more accurately locate areas of abnormal tissue within the prostate, increasing the likelihood of detecting prostate cancer. It also allows for targeted biopsy of specific areas of the prostate, reducing the risk of missing small or difficult-to-locate tumors. Additionally, it may reduce the need for repeat biopsies or unnecessary treatment for benign (non-cancerous) conditions.
What can I expect during the consultation process for PAE?
During the consultation process, patients will meet with a doctor who specializes in interventional radiology to discuss their medical history, symptoms, and treatment options. The doctor will review the patient's medical records, perform a physical exam, and may order additional tests or imaging studies to help determine the best treatment approach. Patients should be prepared to discuss their symptoms, any previous treatments or procedures they have undergone, and any concerns or questions they may have about PAE or other treatment options.
How is PAE different from other treatments for BPH?
PAE is a minimally invasive procedure that can be performed on an outpatient basis, which means that patients can often return home the same day as the procedure with little to no downtime. Additionally, PAE does not require general anesthesia, which can help reduce the risk of complications associated with surgery.
What are the benefits of PAE?
PAE has been shown to be effective in reducing BPH symptoms, with studies reporting improvements in urinary flow rate, reduction in prostate volume, and relief of symptoms such as urinary urgency and frequency. PAE may be particularly beneficial for patients who are not good candidates for surgery, such as those with multiple medical conditions or those who are not able to tolerate anesthesia.
What are the risks and potential complications of PAE?
Like any medical procedure, PAE does carry some risks and potential complications. These may include pain or discomfort in the groin area, difficulty urinating, and a small risk of infection or bleeding. In rare cases, more serious complications such as damage to the bladder or urethra, or pulmonary embolism, may occur. However, the overall risk of complications associated with PAE is relatively low. These include:
Pain or discomfort during or after the procedure
Nausea or vomiting
Urinary tract infection
Blood in the urine,feces or semen
Temporary difficulty urinating or increased urinary frequency
Damage to blood vessels or other structures near the prostate
Allergic reaction to the contrast dye used during the procedure
Who is a good candidate for PAE?
Patients with moderate to severe BPH symptoms who have not responded to medication or who are not good candidates for surgery may be good candidates for PAE. Patients considering PAE should discuss the risks and benefits of the procedure with their doctor to determine if it is a suitable option for their individual needs.
How long does it take to recover from PAE?
Most patients are able to return to their normal activities within a few days of the procedure, although some may experience mild discomfort or urinary symptoms for a week or two after the procedure. Full recovery may take several weeks, and patients may need to avoid strenuous activity or sexual activity for a period of time after the procedure.
Is PAE covered by insurance?
PAE is typically covered by insurance, although coverage may vary depending on the specific policy and the individual patient's medical history. Patients should check with their insurance provider to determine if PAE is covered under their policy.
Are there any long-term risks or side effects associated with PAE?
Long-term studies of PAE have not yet been conducted, so the potential long-term risks or side effects of the procedure are not yet known. However, early studies suggest that the benefits of PAE are sustained over time, with patients experiencing continued improvement in symptoms for up to 5 years after the procedure.
Does PAE cause impotence or other sexual side effects?
There is some concern that PAE may cause sexual side effects such as impotence or decreased libido. However, studies have shown that the incidence of sexual side effects following PAE is generally low, with most patients experiencing little to no change in sexual function. In some cases, PAE may even improve sexual function by reducing urinary symptoms that can interfere with sexual activity.
Can PAE be repeated if necessary?
PAE is a relatively new procedure, and long-term studies are still ongoing to determine its effectiveness and durability over time. However, some studies have suggested that the benefits of PAE can be sustained for several years after the procedure. If symptoms return or worsen over time, it may be possible to repeat the procedure to achieve additional symptom relief.
How does PAE compare to other minimally invasive BPH treatments such as UroLift or Rezum?
UroLift and Rezum are two other minimally invasive treatments for BPH that have been approved by the FDA. While these treatments use different mechanisms to achieve symptom relief (UroLift uses small implants to hold the prostate tissue out of the way, while Rezum uses steam to ablate the tissue), they have been shown to be effective in reducing BPH symptoms in many patients. The choice of treatment may depend on factors such as the size and shape of the prostate, the patient's overall health, and their individual preferences. Patients should discuss the risks and benefits of each treatment option with their doctor to determine which approach is best for them.
How do I prepare for PAE?
Before undergoing PAE, patients will need to have a thorough medical evaluation to ensure that they are healthy enough to undergo the procedure. This may include blood tests, imaging studies, and other tests as needed. Patients will also need to follow specific instructions regarding food and drink intake prior to the procedure, and may need to stop taking certain medications or supplements that could increase the risk of bleeding. Your doctor will provide specific instructions regarding how to prepare for PAE.
How long does it take to recover from PAE?
Recovery time following PAE varies depending on the individual patient and the specific details of the procedure. Most patients are able to go home the same day as the procedure or the following day, and can return to work or other activities within a few days to a week. Patients may experience some discomfort, such as pelvic pain or bladder irritation, for a few days following the procedure, but these symptoms usually resolve within a week or two. Patients should follow their doctor's instructions regarding post-procedure care, including any restrictions on activity or medication use.
How effective is PAE in treating BPH?
Studies have shown that PAE can be highly effective in reducing BPH symptoms in many patients. The exact degree of symptom relief achieved may vary depending on the individual patient and the specifics of the procedure. However, many patients experience significant improvement in urinary symptoms and quality of life following PAE. The long-term effectiveness of PAE is still being studied, but early results suggest that the benefits of the procedure may be sustained for several years.
Are there any restrictions on activity following PAE?
Patients may be advised to avoid heavy lifting or strenuous activity for a few days following the procedure to allow for proper healing. However, most patients are able to resume their normal activities within a few days to a week following the procedure.
How does PAE compare to other treatments for BPH?
PAE is a relatively new treatment for BPH, and it is still being compared to other treatment options in clinical studies. However, early results suggest that PAE may be a safe and effective alternative to other treatments such as medication or surgery for some patients. PAE may be particularly beneficial for patients who are not good candidates for surgery due to age, overall health, or other factors.
How long does it take to see results from PAE?
Patients may begin to experience symptom relief within a few days following PAE, although it can take several weeks or even months to experience the full benefits of the procedure. Results may vary depending on the severity of the patient's condition and other factors.
Are there any long-term effects of PAE?
PAE is a relatively new procedure, and long-term effects are still being studied. However, early results suggest that PAE is a safe and effective treatment option for BPH, with few long-term complications or side effects. Patients should continue to follow up with their doctor following the procedure to monitor their symptoms and ensure that there are no long-term complications.
Can PAE be used to treat prostate cancer?
PAE is not typically used to treat prostate cancer. In fact, PAE may not be recommended for patients with prostate cancer or those who are at high risk for prostate cancer, as the procedure can interfere with the accuracy of future prostate cancer screening tests. Patients with prostate cancer should discuss their treatment options with their doctor.
Will I need to stay in the hospital after PAE?
PAE is typically performed on an outpatient basis, meaning that patients can usually go home the same day as the procedure. However, patients may be required to stay in the hospital for observation for a few hours following the procedure.
What should I expect during the recovery period after PAE?
Patients may experience some mild discomfort or pain in the days following PAE, and may be prescribed pain medication to manage these symptoms. Patients may also experience some urinary symptoms, such as increased frequency or urgency, in the days following the procedure. Patients should avoid heavy lifting and strenuous activity for several days following PAE, and should follow any other instructions provided by their doctor.
Is PAE a permanent cure for BPH?
PAE is not a permanent cure for BPH, but it can provide long-lasting relief from urinary symptoms. Some patients may experience a recurrence of symptoms over time, and may require additional treatment. Patients should continue to follow up with their doctor following the procedure to monitor their symptoms and determine if additional treatment is necessary.
How does PAE compare to other treatments for BPH?
PAE is a minimally invasive alternative to surgical treatments for BPH, such as transurethral resection of the prostate (TURP) or prostatectomy. PAE has been shown to be safe and effective in reducing urinary symptoms in many patients, with lower rates of complications and shorter recovery times than surgical treatments. However, the best treatment approach will depend on the individual patient's medical history, symptoms, and preferences, and should be determined in consultation with a doctor.