NEW ORLEANS, LA USA (UroToday.com) - Given that benign prostatic hyperplasia affects 90% of the male population ages 45-80, there must be a better way to treat the patients than the present treatment. The issue lies in the number of patients who drop out of medical therapy because of reduced ejaculatory function or the creation of erectile dysfunction.
Embolization of the prostatic artery is ideal for any male patient around the age of 55 with IPSS scores greater than 18 and size greater than 20g who are: a) too sick to receive medication therapy, or b) already failed medical therapy, with reduced ejaculatory function and erectile dysfunction. However, consideration needs to be given to older patients who already have atherosclerosis because the small prostatic artery is normally 1 to 2 mm, at best. Side effects from the embolization generally include urethral burning, UTI, hematuria, nocturia, and or rectal pain. Most of the side effects did seem to be self-resolving, though, after the edema and swelling from embolization decreased.
The speaker cited a specific case of a 59-year-old male with an IPSS score of 28, QOL of 6, Qmax 12, and PVR over 200 ml. A CT scan of the patient showed a prostate size 72 cc, which had a negative biopsy, negative blood workup, and a PSA of 4.5. After urodynamic testing the patient was determined to have weak bladder contraction and low flow.
The embolization was done using the Philips EmboGuide®, which, in the second version has been greatly improved. A Foley catheter was used to verify location in the prostate. Before photos of the vascular structure near the prostate showed a clear prostatic artery. After embolization, they showed the reduced blood flow to the prostate. The patient, after 2 months, had an IPSS of 16 with a PVR of 60-90, and a voided volume of 235.
More research needs to be done, but it is speculated that the embolization reduces the volume of the prostate as well as potentially decreasing the density of the capsule. Additionally, there has not been erectile dysfunction or reduced ejaculatory function. It is also noted that, based on the data from a randomized study of over 250 patients in each group, the TURP and embolization had no difference in IPSS scores for the patients after 12 months. Being such a challenging procedure, it is hoped for an improvement in the process, thus also increasing the success rate in each patient.
Presented by Art Rastinehad, DO at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
National Cancer Institute, Rockville, MD USA
Reported by Christopher Pulford (University of California-Irvine), medical writer for UroToday.com