Relief from Prostate Enlargement, Without Surgery

You wake up in the middle of the night with an urgent need to pee. Then, before you can fall back asleep, you have to go again. If you’re a man with a condition called benign prostatic hyperplasia (BPH), this scene is all too familiar.

About half of men ages 50 and older have problems with urination because of BPH. That number increases to 80 to 90 percent in men older than 70.

In BPH, the prostate becomes enlarged to the point that men have problems such as difficulty starting urination, a weak flow, an urge to urinate again soon after urination or the need for frequent urination.

Traditional Treatments for BPH

Until recently, treatments for BPH were limited to medications such as alpha blockers (Flomax or Hytrin) and 5-alpha-reductase inhibitors (Avodart or Proscar) or surgical procedures such as transurethral resection of the prostate (TURP). In TURP, a surgical instrument is inserted into the tip of the penis and then used to trim and remove excess prostate tissue.

There are pros and cons to both treatment approaches.

Medications can help relieve symptoms and reduce the size of the prostate. However, the medications can have unpleasant side effects, including chronic stuffy nose, lightheadedness and loss of libido.

In comparison, TURP surgery is better at improving symptoms more quickly. But in some cases, a prostate is too large to be removed through a TURP procedure. TURP also carries a risk of causing new problems such as urinary incontinence, erectile dysfunction or retrograde ejaculation (the ejaculation of semen into the bladder instead of out through the penis).

A New Treatment Option for BPH

A newer, nonsurgical treatment for BPH, called prostatic artery embolization (PAE), is available at UNC Medical Center in Chapel Hill, says Ari Isaacson, MD, a vascular interventional radiologist who performs the procedure.

PAE is performed through a small puncture in the groin or the arm. A catheter is inserted through the artery and directed toward the prostate.

Once the catheter is positioned in the artery supplying blood to the prostate, tiny particles called microspheres are injected that plug up the artery, blocking blood flow. This is called embolization.

“This process is then repeated on the other side, usually through the same original puncture,” Dr. Isaacson says.

How PAE Works

The PAE procedure blocks the blood flow to the areas of the prostate that are most affected by BPH, causing these areas to become dead tissue. These areas of dead tissue then cause the prostate to soften, alleviating some of the pressure that is causing blockage of the urine.

Over several months, the body’s immune system reabsorbs the dead prostate tissue and replaces it with scar tissue. The scar tissue slowly contracts, resulting in shrinkage of the prostate. Over six months, the prostate will shrink by 20 to 40 percent, resulting in improved and less frequent urination.

General anesthesia is not used for the PAE procedure, so patients are not “put to sleep.” Instead, patients will receive IV medications that take away pain and anxiety and make them comfortable through the procedure.

“The procedure can take anywhere from one to three hours, depending on the location and size of the prostatic arteries,” Dr. Isaacson says. “Then, most patients go home the same day.”

The Path to Better Prostate Health

Because the PAE procedure does not involve surgery or physical removal of part of the prostate, patients will not see results immediately. The first changes are seen most commonly one to two months after the procedure, with continued improvement until about four months.

The most common side effects of PAE immediately after the procedure include urethral burning and increased urinary frequency. These side effects usually stop within a week.

The good news? According to Dr. Isaacson, about 75 to 80 percent of men treated with PAE experience a significant and lasting improvement.

UNC Medical Center is one of just a few hospitals in the U.S. that offers PAE to patients who are not enrolled in a clinical trial. Appointments for evaluation are available in Chapel Hill, Raleigh, Hillsborough and Siler City. You can make an appointment or email for more information.