Dr. Robert Hanna, M.D., interventional radiologist at Banner Desert Medical Center in Mesa, AZ. For more information on this topic, speak with your doctor, or contact the Banner Desert Interventional Radiology department at 480-412-6327.
Question: I have an enlarged prostate and difficulty urinating. What are my treatment options?
Answer: Enlarged prostate, also referred to as benign prostatic hyperplasia, is one of the most common prostate problems occurring in men over the age of 50. The current treatment options for men with enlarged prostates are a prostate artery embolization (PAE), transurethral resection of the prostate (TURP) or laser.
PAE is a new, minimally invasive treatment option. Unlike other treatment options, PAE is not done through the penis or urethra. The treatment is performed through an angiogram, where an interventional radiologist will insert a catheter into a blood vessel through a small incision in the groin or wrist. The radiologist will thread the catheter through the blood vessel and into the prostate. Beads will then be placed in the prostate’s blood vessels to block the blood supply. As the prostate is deprived of oxygen, it will soften and shrink. The procedure takes between 1.5 to 3 hours, depending on the size of the patient’s blood vessels. Within two weeks of the procedure, improved urination symptoms should be present.
PAE is an outpatient procedure. The procedure requires minimal recovery time—45 minutes to 3 hours depending on the entry point of the catheter. One possible complication of this procedure is that the beads can shift, which may injure the bladder or rectum. However, this is rare and only occurs in 0.5 percent of cases, and usually heals on its own.
The TURP and laser procedures are more invasive, and performed by an urologist.
For the TURP procedure, the surgeon will insert a cystoscope, a thin lighted viewing tool, through the penis and into the urethra. Then, with the use of a small cautery loop, the surgeon will cut away the enlarged lobes of prostate tissue that are causing the blockage. While this procedure is considered the gold standard, it requires going through the penis and retrograde ejaculation (semen traveling backwards into the bladder rather than out of the urethra) is a common side effect.
Lasers are also done through the penis and used in outpatient treatments. While this procedure can improve urinary symptoms, retrograde ejaculation is a possible side effect.
PAE is a favorable option for men whose prostates are bigger than 80 grams, experience bleeding after a TURP or have had surgery/anesthesia and can’t have their urine catheters removed because of the large prostate. Since the PAE procedure goes through the artery rather than the penis, many patients find it preferable.
PAE treatment cannot be used to treat cancer.