Under What Knife?

Prostate therapy as good as cancer surgery

(RxWiki News) A new, less invasive treatment - called prostatic artery embolization - may replace the most common way doctors treat men with an enlarged prostate, or benign prostatic hyperplasia.

Researchers found that prostatic artery embolization is as effective as the current surgery procedure - called transurethral resection of the prostate (TURP).  Prostatic artery embolization mitigates risks such as sexual dysfunction, loss of bladder control, blood loss, and retrograde ejaculation (semen entering the bladder instead of leaving through the urethra).

dailyRx Insight: A new treatment for enlarged prostate is safer and works just as well as surgery.

In a study led by João Martins Pisco, M.D., chief radiologist at Hospital Pulido Valente and director of interventional radiology at St. Louis Hospital in Lisbon, 84 older men with enlarged prostates were treated with prostatic artery embolization. After following the men for over nine months, the researchers found that 98.5 percent of patients showed improvements. The majority of the men showed "excellent" improvement.

Prostatic artery embolization reduces the size of a man's prostate by blocking blood flow to the prostate with tiny particles. A trained doctor injects these tiny particles through the groin into the femoral artery.

After this treatment, most men feel a little or no pain, usually leaving the hospital within 8 hours. Unlike patients TURP, prostatic artery embolization did not lead to sexual dysfunction. In fact, about one quarter of men in the study reported improved sexual function.

Almost all men experience some degree of prostate enlargement as they age, with one out of every four men experiencing benign prostate growth by age 80. Benign prostatic hyperplasia, commonly referred to as BPH or simply an enlarged prostate, happens with the prostate grows larger in a non cancerous manner, and can cause difficulty with urination (incomplete emptying, weak stream, trouble starting), ejaculation, and lead to more frequent urinary tract infections. If a man experiences these symptoms, diagnosis will first be made to rule out prostate cancer with a digital rectal exam and prostate specific antigen blood test. In the absence of cancer, tests will be run on the kidneys and bladder (urinalysis, post-void residual urine volume, cystoscopy) to rule out mechanical dysfunction. Management includes lifestyle modifications such as restricting fluid intake, avoiding diuretics like alcohol and caffeine, and following a schedule for urination. Medications are also available to treat symptoms, such as alpha blockers (Cardura, Flomax, Hytrin, Uroxatral) to improve urine flow, and 5α-reductase inhibitors (Avodart, Propecia) to reduce the size of the enlarged prostate. 

These findings were presented at the 36th Annual Scientific Meeting of the Society of Interventional Radiology. 

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Review Date: 
March 29, 2011