As many as half of individuals with a prostate over the age of 50, and nearly three-fourths older than 70, have benign prostatic hyperplasia (BPH), in which their enlarged prostate compresses the urethra — the tube that carries urine out of the bladder. While rarely life-threatening, BPH can significantly hamper quality of life through symptoms that include a weak urinary stream, frequent urination and an inability to completely empty the bladder. Medication can provide modest improvement, but many need more. Surgery, though effective, isn’t an appropriate option for everyone and can come with unwanted side effects.
For those seeking a middle ground, UCLA Health offers a minimally invasive treatment option in which an interventional radiologist blocks the prostatic arteries, reducing the blood flow as a way of shrinking the prostate so that it no longer interferes with the flow of urine. Prostatic artery embolization (PAE) was recently added to the American Urological Association’s standard-of-care guidelines as a safe and effective nonsurgical treatment option for men with BPH. UCLA has among the most extensive experience in the United States with the procedure, having performed more than 600 in a little more than a decade.
“Millions of individuals continue to suffer from the symptoms of BPH, either because they’re concerned about the side effects of surgery or they don’t qualify due to advanced age or coexisting medical conditions,” says Justin McWilliams, MD, UCLA Health interventional radiologist who was among the first in the nation to do a PAE, in 2012. “PAE fills the gap as a safe and effective alternative when lifestyle modifications and medications are insufficient and surgery either isn’t an option or isn’t desired.”
In the PAE procedure, an interventional radiologist uses X-ray guidance to pass tiny catheters into the pelvic arteries, then performs an angiogram — an X-ray in which contrast dye is injected — to map the blood vessels and locate the ones going to the prostate. At that point, inert plastic beads are placed to block the prostate’s main blood supply. The same procedure is repeated on the opposite side, and an additional angiogram confirms that the overall objective has been achieved. Dr. McWilliams notes that PAE requires only moderate sedation or local anesthesia. Patients go home the same day and can return to their everyday activities within a week. Symptom relief generally starts within one-to-two weeks, improving progressively over the course of two months.
In a study of more than 2,000 patients who had the PAE, 80% experienced significant symptom improvement — typically better than medication, though not as good or as durable as after transurethral resection of the prostate (TURP), which is considered the surgical gold standard. However, TURP is associated with sexual side effects, most commonly retrograde ejaculation. Minimally invasive BPH surgeries are now available that can preserve sexual function, Dr. McWilliams notes, but PAE side effects are milder and recovery is faster.
And because there is no upper limit to the prostate size PAE can successfully treat, it’s also a good option for those whose prostates are too large for traditional surgery. Dr. McWilliams and his interventional radiology colleagues work closely with UCLA Health urologists to help patients with BPH determine which procedure would be best for them.
“BPH can have a huge disruptive effect on a person’s life, to the point that many aren’t sleeping well and can’t participate in normal activities without constant interruptions or worries,” Dr. McWilliams says. “We are pleased to be able to offer this option to those who either don’t want surgery or for whom surgery isn’t an option — and it’s extremely rewarding to see significant improvement in so many of our patients.”
