WHY IS AN ENLARGED PROSTATE A CONCERN?

Usually an enlarged prostate is not a serious problem; it’s very common as men age. But, over 30 percent of men aged 50 and over require treatment for an enlarged prostate and for some of them that means surgery.

The prostate gland sits underneath the bladder and surrounds part of the urethra, the tube that carries urine and semen out of your penis. Normally, it’s the size and shape of a walnut, but as men age it can sometimes get too big and start to squeeze the urethra. This is called benign prostatic hyperplasia (BPH).

BPH can disturb sleep with frequent urination overnight, cause difficulty urinating, or cause a weak stream. When BPH begins to affect quality of life, there are a number of treatment options available, ranging from lifestyle changes to medication to a variety of surgical options.

In cases of surgery, the most commonly performed procedure to address BPH symptoms is a transurethral resection of the prostate (TURP). During this procedure, an instrument is inserted into the tip of your penis and extended through your urethra into the prostate area. Your doctor will then use it to trim tissue from the inside of your prostate gland, one small piece at a time, to remove the section of the prostate that is blocking urine flow. As small pieces of tissue are removed, irrigating fluid carries them into your bladder.

There is also a minimally invasive alternative to surgery, called prostate artery embolization (PAE). It is used to block blood flow to the prostate. A doctor, called an interventional radiologist, uses X-ray guidance to move a small plastic tube through the groin and into the small arteries which are feeding the prostate. Then tiny particles are injected into the arteries to starve the prostate of its blood supply, shrinking it.

HOW DOES PAE COMPARE TO SURGERY?

First performed in 2009, PAE is a relatively newer procedure compared to TURP, but it has proven to be a safe and effective treatment for an enlarged prostate. PAE is less invasive than surgery with no risk of bleeding and other surgical complications, and no impact on erectile or sexual function. It can also effectively treat very large prostates for which TURP is not an effective option. Plus, PAE is an outpatient procedure with same-day discharge, and recovery from the procedure is fast with patients often returning to normal activities within a week.

During PAE, the prostate is slowly deprived of its blood supply so it may take up to 3-6 months for you to see the full benefit, although you should start to feel better after a week. In about 10 percent of cases the interventional radiologist is not be able to position the catheter adequately to block blood flow and, rarely, there is a risk that the injection particles do not go into the correct area.

In contrast, TURP can provide relief from urinary symptoms upon recovery from surgery, but surgical recovery isn’t as fast with a longer hospital stay required and a slower return to work or normal activities. Plus, almost all men who have the procedure experience retrograde ejaculation – ejaculation into the bladder. This does not affect erectile function, but alters the experience of ejaculation and affects your ability to father a child.

A small risk of significant bleeding, infection, and incontinence have also been associated with a TURP procedure.

HOW DO I GET PAE?

PAE procedures are covered under the Alberta Health Care Insurance Plan. Your doctor or specialist will need to fax a consultation request to Rockyview General Hospital’s Diagnostic Imaging department at 403-252-2157. Once the information has been received our interventional radiology team will review the request and contact you to arrange a consultation to determine if the procedure is appropriate based on your medical history. There may also be imaging required.

For more information visit our interventional radiology page, or contact us at 403-777-3000.

REFERENCES

Gao, Y., et al. (2014) “Benign Prostatic Hyperplasia: Prostatic Arterial Embolization versus Transurethral Resection of the Prostate—A Prospective, Randomized, and Controlled Clinical Trial.” Radiology, Mar; 270 (3): 920-28. Accesses April 17, 2019.

Healthwise Staff (2018) “Transurethral Resection of the Prostate (TURP): What to Expect at Home.” www.myhealth.alberta.ca. Accesses April 17, 2019.

Mayo Clinic Staff (2018) “Benign prostatic hyperplasia (BPH).” www.mayoclinic.org. Accessed April 15, 2019.