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In the quest for newer and more effective BPH treatment, scientists have developed a new technology called prostatic arterial embolization, a minimally invasive procedure that can be performed on an outpatient basis. A report about the success of prostatic arterial embolization was presented at the XXXIII Brazilian Congress of Urology by Francisco C. Carnevale, University of Sao Paulo Medical School, and his associates.
Prostatic arterial embolization, which was developed at the University of Sao Paulo Medical School, works like this. First, a radiologic procedure is used to map the patient’s blood supply to the prostate gland. Then a clinician accesses the blood flow to the prostate through a percutaneous puncture and catheter in the patient’s upper thigh. He or she then introduces Embosphere® Microspheres, minute spherical particles engineered to block the blood supply to the prostate, causing the gland to eventually shrink. The entire procedure takes about 2.5 hours.
Carnevale and associates conducted a phase II study that involved 11 men aged 59 to 78 years with BPH who had not responded to oral alpha-blockers for BPH. After the men underwent prostatic arterial embolization, the prostates reduced in size by an average of 30 percent. Ten of the 11 men had BPH symptom relief and their catheter was removed after an average of 12 days. After a minimum 10-month follow-up, the ten men were deemed a clinical success and reported a significantly improved quality of life. In the one remaining patient, the prostate had reduced in size by only 5 percent, and after undergoing two embolizations he was referred for a transurethral resection of the prostate (TURP).
In addition to being a minimally invasive procedure, prostatic arterial embolization also is not associated with major side effects such as urinary incontinence, erectile dysfunction, retrograde ejaculation, and blood loss, which can occur after other BPH treatment. In fact, the side effects reported after the prostatic arterial embolizations performed by Carnavale’s team included mild pain in the perineal region in all men, slight rectal bleeding in 3 of 12 (one of the men underwent two embolizations), diarrhea in 2 men, and bladder ischemia in 1.
Joao Martins Pisco, MD, chief radiologist at Hospital Pulido Valente and director of interventional radiology at St. Louis Hospital, both in Lisbon, Portugal, also has been working with prostatic arterial embolization. At the 2011 annual meeting of the Society of Interventional Radiology in Chicago, Pisco reported on his experience with 84 men with BPH who had not responded to other BPH treatments.
After an average 9-month follow-up, prostatic arterial embolization was declared successful in 98.5% of the men. Extreme improvement of BPH symptoms was reported by 91.7% of the patients, 7.1% had slight improvement, and one (1.2%) reported no improvement.
Similar to the Carnevale study, Pisco reported no major complications. “While the gold standard treatment for enlarged prostates has been TURP,” he said, “minimally invasive prostatic artery embolization is safe, performed under local anesthesia, and has comparable clinical results—without TURP’s complications.”
According to Carnevale, “An estimated 25 percent of benign prostatic hyperplasia patients fail or experience clinical complications from medical treatment. Currently, approximately 500,000 men undergo surgery every year in the US for BPH.” Therefore, a great number of men could benefit from prostatic arterial embolization. Now for the less-than-good news: prostatic arterial embolization is still in its preliminary stages and so is not available for the public yet, but additional research is being pursued.
Carnevale FC. Presented at the Brazilian Congress of Urology, November 22-26, 2011, Santa Catarina, Brazil
Knaub J. Prostate embolization. Radiology Today 2011 May; 12(5): 28