PAE a Non Surgical boon for patients with Enlarged Prostate in 2020!

Believe it or not for benign or non-cancerous condition aka BPH can be far more problematic with greater implications for a man’s quality of life than prostate cancer.

Benign prostatic hyperplasia affecting men’s health worldwide?

Enlarged Prostate aka Benign prostatic hyperplasia (BPH), is a condition that will affect half of men over 50 and 80% of those aged over 80. As its name suggests, it’s a non-cancerous increase in the size of the prostate gland. In some instances, it can lead to lower urinary tract symptoms (LUTS), which can result in an inability to empty the bladder sufficiently. It’s a growing, and often-uncomfortable condition. Typically, patients go to Urologist, who will either prescribe medication or perform a surgical procedure such as transurethral resection of the prostate (TURP). While medication can occasionally offer rapid symptomatic relief, for some men a response could take months. Some medications can also be associated with negative side effects like erectile dysfunction. Although surgical TURP is regarded as a cost-effective alternative to medication, it can cause side effects that can impact a patient’s quality of life, and a recovery time of up to several weeks.

Prostate artery embolization gaining popularity!

However, there is a third route that is increasingly gaining popularity: Prostate Artery Embolization (PAE). In fact, it’s one of the most exciting areas in medicine today. Prostate artery embolization was pioneered by the late, great Professor Joao Pisco of Saint Louis Hospital in Lisbon – to whom much credit must be given. A landmark study conducted by Dr. Pisco’s team was recently published in European Urology journal in December 2019. This team found that the improvements in subjective and objective variables after prostate artery embolization are far superior to those caused simply by placebo effect. PAE procedure got a lot of attention in India with key opinion leaders such as Dr. Virender Sheorain spreading the awareness.

How PAE procedure is performed :

During PAE, Image guidance (like angiography) is used to place a microcatheter (tiny tube) into the prostate arteries, from a tiny cannula in the wrist or thigh. Selectively embolizing these prostatic arteries causes the prostate to shrink. There are too many benefits of PAE for patients: it’s definitively less invasive than Surgery (TURP) but is just as effective. It can be performed with almost no discomfort to patient, who can go home hours after the procedure. Another great advantage is that PAE approaches the prostate through the arteries, leaving the urethra untouched, thereby avoiding many potential surgical complications as retrograde ejaculation, erectile dysfunction, incontinence or urethral structures.

Challenges in PAE:

PAE procedure is not without challenges. Human pelvis has a complex anatomy with multiple tiny collateral arteries on each side. Hence only endovascular specialist such as Dr. Sheorain who are well trained and experienced in prostate embolization shall perform PAE.

Status of Prostate artery embolization in India:

Many hospitals and outpatient interventional centers in India are just starting to perform this sophisticated procedure. One should know that because of challenging anatomy of prostatic arteries, a high-end machine with special software is needed to achieve better result. Hence, imaging of the prostatic arteries and guidance into the prostate is of paramount importance to allow a safe and effective targeting of the prostate, avoiding non-target embolization to surrounding organs. Over the past 10 years, Endovascular Specialists such as Dr. Sheorain have worked with cone beam CT in combination with 3D Roadmap to overcome this navigation issue. By using these solutions together, the guide wire and catheter can be navigated through complex vessel structures by providing live fluoroscopy overlay on 3D angiography.

As we enter a new decade, Dr. Sheorain is encouraged to see how advances in this field particularly of prostate disease – are transforming the way we treat BPH patients, helping our patients to get home more quickly and with limited side effects.

Future of PAE Procedure :

The results of most recent studies are encouraging and suggest that prostate artery embolization may soon become the standard of care for benign prostatic hyperplasia.

References

• [Brett A. S. (2013) Prevalence of Occult Prostate Cancer at Autopsy is High. NEJM Journal Watch – https://www.jwatch.org/na31811/2013/08/08/prevalence-occult-prostate-cancer-autopsy-high
• What is Benign Prostatic Hyperplasia (BPH)? –
  https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)
• Egan, K.B. (2016) The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urologic Clinics, 43(3):289-97.
  https://www.ncbi.nlm.nih.gov/pubmed/27476122rough the urethra
• Saigal, C. S. & Joyce, G (2005) Economic costs of benign prostatic hyperplasia in the private sector. J Urol 173, 1309–13. https://www.auajournals.org/doi/10.1097/01.ju.0000152318.79184.6f
• Recovery – Transurethral resection of the prostate –
  https://www.nhs.uk/conditions/transurethral-resection-of-the-prostate-turp/recovery/#targetText=Returning%20to%20your%20normal%20activities,return%20to%20your%20normal%20activities
• Pisco J. et al. (2019) Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia. European Urology.
  https://www.europeanurology.com/article/S0302-2838(19)30873-5/fulltext
• Bilhim T., Tinto H.R., Fernandes L. & Pisco J.M. (2012) Radiological anatomy of prostatic arteries. Techniques in Vascular & Interventional Radiology, 15(4):276-285.
• J Vasc Interv Radiol. 2019 May;30(5):638-644. doi: 10.1016/j.jvir.2019.02.014.
  https://www.ncbi.nlm.nih.gov/pubmed/31029381
• Pisco J.M., Bilhim T., Pinheiro L.C., Fernandes L., Pereira J., Costa N.V., Duarte M. & Oliveira A.G. (2016). Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. Journal of Vascular and Interventional Radiology, 27(8), 1115-1122.
  https://www.ncbi.nlm.nih.gov/pubmed/27321890

For further information of PAE please visit www.vasculardoctorindia.com or call 9868887666 to schedule an appointment with Dr. Virender Sheorain, best doctor for enlarged prostate treatment without surgery at Medanta Hospital Gurgaon.