Prostate Artery Embolization – A Non-Invasive Treatment for BPH

An enlarged prostate, medically called benign prostatic hyperplasia (BPH), is a common urological condition affecting half of men ages 50 and older. It is known to cause a range of urinary problems. Prostate Artery Embolization (PAE) is a minimally invasive outpatient procedure used to successfully treat BPH with a lower risk of urinary incontinence and sexual side effects than more invasive surgical procedures. Dr. Hsu, an interventional radiologist with ARA Diagnostic Imaging in Austin, Texas, discusses this leading-edge approach with KEYE-TV’s Trevor Scott on CBS Austin’s “We Are Austin.”

(Trevor Scott) Welcome back to “We Are Austin.”

Today, we’re looking at a topic that is super important to older men. We’re talking about prostate health. As men get older, they may find that they are having uncomfortable symptoms of an enlarged prostate.

Interventional radiologist Dr. Connie Hsu, from ARA Diagnostic Imaging, is here this morning to talk about prostate artery embolization or PAE, which is a minimally invasive, leading-edge procedure that can bring significant improvement for men. And I’m sure that is music to many ears out there.

Good morning, Doctor. Thanks for joining us.

(Dr. Connie Hsu) Oh, thank you so much for having me. Always fun to be on your show.

(Trevor) It truly is. And there are always such great conversations, and you put things so well for people to completely understand.

Let’s actually start right there. Really, what is an enlarged prostate?

(Dr. Hsu) Well, I want to show you the first slide because we’re going to do a little bit of anatomy teaching. So normally, patients have a bladder, and there is a urethra that empties that bladder, and the prostate gland flanks that bladder.

Unfortunately, as men get older, that prostate gland actually enlarges, and as it enlarges, it squeezes that urethra opening. So when that prostate gland enlarges, it’s what we call medically, terminology-wise, benign prostatic hyperplasia. And so BPH, the short word for that, is when that prostate gland enlarges, squeezes that urethra opening, and causes urinary symptoms in men as they get older.

(Trevor) Interesting. Thanks for spelling that out. It really does help to hear those terms and to see it as well.

So, when we’re talking about this issue, what does a man who is experiencing this enlarged prostate, what are the symptoms? What does this person experience?

(Dr. Hsu) So typically, it’s urinary symptoms that they experience, obviously, as the bladder is not able to empty itself. Men frequently present with a weak stream. They have urinary frequency or urgency. They’re straining when they’re trying to urinate. And many of our men actually have to get up frequently at night, 3 to 4 times at night, to urinate. And so obviously, that impacts on their quality of sleep, impacts on their quality of life.

And so, you know, we’re talking about symptoms that affect a lot of men as they get older.

(Trevor) Yeah, you’re absolutely right. And that may sound familiar to plenty of men out there. So, if they’re thinking about this, what are typical ways, the typical ways of treating an enlarged prostate?

(Dr. Hsu) Well, obviously, the first line is some lifestyle changes: reducing your fluid intake in the evenings and decreasing your caffeine and alcohol intake. And the first line, obviously, in medicine is medical therapy. So, doing medications that will help with the urinary symptoms related to that enlarged prostate gland.

Only when medical therapy fails where it’s not enough and not working. Then, in the past, the next step was surgical treatment. Often, that involved going in surgically and cutting that tissue, that prostate tissue that was blocking that urethra opening, and a lot of those surgically invasive techniques also involve going in using maybe heat, vaporization, to open up that tissue.

But all that involves instrumentation, correct?

So, one way to think sort of more outside of the box is, what if we went intravascularly into that prostate gland blood flow supply and reduced the flow feeding that prostate gland tissue in order to essentially put it on a diet?

And that’s what prostate artery embolization is.

(Trevor) Interesting. I love to hear that.

So, what are the benefits of this prostate artery embolization versus some of those traditional treatments?

(Dr. Hsu) So, first of all, it’s minimally invasive, which means that the complication rate is extremely low, less than 0.5%. Surgical complications typically range from 1 to 2%. And the key thing for men is that there is no risk of sexual dysfunction, no risk of urinary incontinence because we’re not instrumenting down there.

And the nice thing is that unlike some of the surgical interventions, including the new invasive techniques, patients do go home with a urinary catheter. For prostate artery embolization, they don’t go home with a urinary catheter at all.

(Trevor) That seems like an incredible improvement. What a great option.

So how actually does it work, prostate artery embolization?

(Dr. Hsu) So, what we do is we catheterize the artery via the groin or the wrist. No different than if we’re doing a heart cath. Instead, we’re catheterizing teeny tiny blood vessels perfusing that prostate tissue. And when I mean teeny tiny, I’m talking about 1.5-millimeter-sized prostatic arteries on each side.

And once we’re able to get in, we deliver these FDA-approved beads that go in, plug in the blood flow supply to that prostate tissue in order to put it on a diet.

(Trevor) That’s fascinating to hear. So, this is permanent. This is a permanent option?

(Dr. Hsu) Yes.

So, these days, we’ve been using it for the past 20 to 30 years in women with uterine fibroid embolization. So, it has a known proven safety and efficacy among women for decades. And so now it’s being applied to men for their prostate tissue, and it’s FDA-approved specifically for prostate artery embolization. But it’s known to be safe in women. So, it’s definitely safe for men.

(Trevor) Wow. That’s incredible.

Is there any pain associated with the procedure?

(Dr. Hsu) Actually, it’s very mild pain. So sometimes, our patients may take a little bit of Tylenol or ibuprofen, but there’s really very mild pain associated with this procedure. Actually, in fact, most patients are going to have a little bit of worsening of their urinary symptoms for the first few days after prostate artery embolization because, obviously, that prostate gland is going to be a little bit ticked off being put on a diet. But by the end of the week, they’re back to base.

(Trevor) Well, that’s wonderful to hear that there is not much pain associated with it.

So, it’s done. Men that are finished with the procedure, how do they feel then, and what can they expect?

(Dr. Hsu) Well, obviously, during that first week, they’re going to have some worsening of their urinary symptoms because that prostate gland is going to be a little bit angry being put on a diet. But obviously, by the end of the week, they’re back to status quo. And as each week passes, hopefully, their urinary symptoms get better and better.

I typically will see my patients at a one-month and three-month time period. About two-thirds of our patients at one month are definitely starting to see improvement of urinary symptoms. So that potentially, by the second month, they’re getting off of prostate medications. Another one-third of patients may be slowly shrinking that prostate tissue. So, I will tell them at their one-month follow-up to just be patient. And typically, by three months, they’re obviously noticing some improvement.

In terms of prostate artery embolization efficacy, the success rate is about 84 to 74%. So pretty good.

(Trevor) That is good information to know. Thank you so much.

So, how can men find out more about prostate artery embolization?

(Dr. Hsu) Well, obviously, talking to your primary care doctor or your urologist about prostate artery embolization. We actually have a very collaborative relationship with our urologists here in the Austin metroplex.

(Trevor) That’s great.

(Dr. Hsu) And looking online, we have for informational items online to learn a little bit more about prostate artery embolization. And if you’re a good candidate, then you can be set up for a consultation with one of my partners or myself to talk further about prostate artery embolization as a treatment option.

I’ve had many patients that have researched on their own and probably know a lot of information more than I do sometimes!

(Trevor) We are in that informational age, that’s for sure. But I promise they don’t know more than you, Dr. Hsu. Thank you. Thank you so much for joining us today.

A really important and effective technique for a lot of men out there, and I’m sure they’re happy to hear it.

Thanks for joining us.

(Dr. Hsu) Thank you.

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