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No-Scalpel Treatment for Enlarged Prostate

Prostatic Artery Embolization May Help When Medications Don't, Study Finds

Living With Benign Prostatic Hypertrophy

When the prostate, normally a walnut-sized gland, grows in mid to late life, it can clamp down on the urethra, decreasing or shutting off the flow of urine and causing many sleep-stealing trips to the bathroom.

The condition is called benign prostatic hyperplasia (BPH), and it’s estimated to affect as many as 19 million American men.

Medications can sometimes help, but for some, the problem requires a procedure to reduce the size of the prostate.

The gold standard for treating BPH is considered to be less invasive surgery called transurethral resection of the prostate (TURP) where, under anesthesia, doctors thread a heated wire loop up through the penis and use it to cut and remove sections of the prostate.

Side effects from TURP may include retrograde ejaculation, bleeding, incontinence or leakage, and difficulty having an erection. Experts say, however, that most men who could have erections before their procedure will be able to have them after. Surgery doesn’t usually restore lost sexual function, however.

TURP is performed in 90% of cases where treatment is needed, but sometimes the prostate is too large and requires open surgery.

Less commonly, some centers are offering newer procedures using lasers to vaporize prostate tissue or microwave heat therapy to ablate tissue that’s blocking the urethra.

Looking at a Different Option

For the trial, researchers in Portugal enrolled 84 men who ranged in age from 52 to 85 with severely enlarged prostates who had tried medications but still had not gotten relief from their symptoms after at least six months on the drugs.

Overall, 98.5% of procedures were considered to be technical successes, meaning that doctors were able to seal off at least one out of four of the arteries that feed the prostate.

An average of nine months after their procedures, researchers reported that 77 men had “excellent” improvement. Six men had “slight” improvement but needed no medications. And one had no improvement because the procedure couldn’t be completed.

Overall, improvement on a scale that ranks symptom severity from 1 to 35 points was about 14 points. On average, the men started with a score of 22 and improved to a score of 8, researchers say.

“That would be a pretty impressive response to therapy and comparable to a lot of other things that have gained traction and become part of our armamentarium for treating BPH,” says Stephen M. Schatz, MD, assistant professor at Brady Urological Institute at Johns Hopkins University School of Medicine, who was not involved in the study. “If the results are reproducible and real, that represents something promising.”

There were eight clinical failures, Pisco says, meaning that the men only had slight or no improvement after their procedures.

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