Q&A: What PCPs should know about prostate artery embolization

Key takeaways:

• Benign prostatic hyperplasia is the most common benign tumor found in men.
• Prostate artery embolization is recommended for men with moderate to severe BPH symptoms who prefer nonsurgical treatment.

In recognition of National Men’s Health Week, the Society of Interventional Radiology hosted a congressional press briefing on prostate artery embolization, a procedure used to treat benign prostatic hyperplasia.

“The biggest barrier to treatments like prostate artery embolization [PAE] is public awareness,” Alda L. Tam, MD, MBA, FSIR, FACR, president of the Society of Interventional Radiology, said in a press release. “Highlighting innovative, evidence-based treatments like this will help equip medical professionals with knowledge about the latest treatment advancements available to their patients so they can positively impact their lives.”

According to Johns Hopkins Medicine, benign prostatic hyperplasia (BPH) is the most common benign tumor found in men. BPH symptoms — such as difficulty urinating, weak urine streams and increased frequency of urination — occur in about one in four men by age 55 years and in half of men by age 75 years. Additionally, 20% to 30% of men experience symptoms severe enough to require treatment by age 80 years.

The symptoms of BPH can be caused by urethral obstruction or changes in the bladder, according to Johns Hopkins. Left untreated, urethral obstruction can potentially lead to thickened bladder, infected residual urine or bladder stones and pressure that may damage the kidneys.

Despite the risk for substantial urinary tract damage, “millions of men avoid treatment for [BPH] because of the risks of surgery, including sexual side effects and leakage,” Shivank Bhatia, MD, FSIR, the chair of interventional radiology and a professor of interventional radiology and urology at the University of Miami Health System and the Miller School of Medicine, said in the release. “PAE avoids these risks while achieving long-term positive clinical outcomes.”

Speaking to Healio, Bhatia explained what the PAE procedure entails, which patients are recommended for the treatment and the type of follow-up care that should be administered in post-PAE scenarios.

Healio: What outcomes are you hoping to achieve with briefings like this?

Bhatia: To make sure that patients are aware of this option and to make sure that primary care physicians are aware of this option because they are the gatekeepers. We have 21.5 million men in the United States suffering from an enlarged prostate, and around 14 million are eligible for treatment but only 1% get treatment from a urologist. Guess what’s happening to the 99%? They are being managed by primary care. This is huge.

Healio: What is PAE?

Bhatia: It is an outpatient minimally invasive image guided procedure to treat BPH (also known as enlarged prostate). The procedure works by blocking the blood flow to the enlarged prostate using tiny particles, thereby reducing its size and relieving urinary symptoms.

Healio: Which patients are recommended to undergo PAE?

Bhatia: PAE is recommended for patients who have moderate to severe urinary symptoms (like urinary urgency, frequency, poor stream, incomplete emptying, waking up at nighttime) caused by BPH and prefer a nonsurgical treatment option. It is particularly suitable for patients with large prostate glands (over 60 mg) and those who are not good candidates for surgery due to their overall health or preference to avoid surgical interventions. It is also recommended for men who wish to avoid side effects of medications.

Healio: What type of follow-up care should patients receive following PAE?

Bhatia: Following PAE, patients should receive regular follow-up care, which typically includes scheduled visits with their urologist. These visits allow the urologist to monitor the patient's progress, assess symptom improvement and address any potential complications or concerns that may arise.

Healio: What else should PCPs know about PAE?

Bhatia: PCPs should be aware that PAE is a safe and effective treatment option/alternative for treating BPH related symptoms. It has been shown to provide significant symptom relief and improve quality of life for many patients. PCPs should also know that PAE is a minimally invasive procedure that is performed by an interventional radiologist, and it does not require general anesthesia or a hospital stay.

Healio: Anything else to add?

Bhatia: PAE has the added advantage that there is no risk of sexual side effects (like erectile dysfunction and retrograde ejaculation) or urinary incontinence. These side effects can occur after more invasive surgical treatment for BPH. It's worth mentioning that PAE has a shorter recovery time compared to traditional surgical interventions for BPH. Most patients can resume their normal activities within a few days after the procedure.

References:

• Benign prostatic hyperplasia (BPH). https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph. Accessed June 12, 2023.
• The Society of Interventional Radiology hosts Men's Health Month briefing to raise awareness of cutting-edge treatments. https://www.prnewswire.com/news-releases/the-society-of-interventional-radiology-hosts-mens-health-month-briefing-to-raise-awareness-of-cutting-edge-treatments-301838850.html. Published May 31, 2023. Accessed June 9, 2023.