About Prostate Artery Embolization
Benign prostate hyperplasia (BPH) is a condition more commonly known as enlarged prostate.
BPH involves hyperplasia of prostatic cells, resulting in the formation of large, fairly discrete nodules in the prostate. When sufficiently large, the nodules compress the urethral canal. This can cause partial, or sometimes virtually complete, obstruction of the urethra.
Prostate Artery Embolization is a relatively newer, non-surgical treatment for BPH.
As many men well know, an enlarged prostate interferes with the normal flow of urine and causes discomfort and inconvenience. This new procedure, which is still being studied, promises new hope for men with enlarged prostate.
RIA Endovascular physicians work collaboratively with your urologist to make sure that your symptoms are related to BPH and that prostate artery embolization is an appropriate treatment.
What are the symptoms of benign prostate hyperplasia (BPH)?
Symptoms of enlarged prostate include:
- Urinary frequency Urinary urgency Hesitancy – difficulty initiating the urinary stream
- Interrupted, weak stream Incomplete emptying of the bladder – feeling of persistent residual urine, regardless of the frequency of urination
- Straining – need to strain or push to initiate and maintain urination to more fully empty the bladder
- Decreased force of stream – loss of force of the urinary stream over time
- Dribbling – loss of small amounts of urine due to poor urinary stream
How common is BPH?
Benign prostate hyperplasia occurs in 34.4 per 1,000 men over age 55 every year in the United States. BPH occurs increasingly with age.
The prevalence of enlarged prostrate increases with age.
Histologic (discernible with a microscope) BPH occurs in approximately
- 8% of men ages 31 to 40
- 50% of men ages 51 to 60
- 70% of men ages 61 to 70
- 90% of men ages 81 to 90
Symptomatic (clinical) BPH is present in approximately
- 26% of men in their 50’s
- 33% of men in their 60’s
- 41% of men in their 70’s
- 46% of men in their 80’s and beyond
The prevalence of lower urinary tract symptoms secondary to BPH in the U.S. population is 41% in black men and 34% in Caucasian men.
How is it diagnosed?
The only lab test that is universally recommended for BPH is urinalysis. Serum prostate-specific antigen (PSA) levels are used as a marker for prostatic diseases, including BPH.
Imaging studies can help confirm prostate size. BPH is diagnosed based on a written clinical history, a digital rectal examination (DRE) findings, and focused neurologic examination findings.
What are the prostate treatment options?
There are several options for patients who suffer with BPH. When considering a possible treatment plan, your physician and you will want to consider your symptoms, the severity of the symptoms, lifestyle considerations and your own preferences. Options to treat BPH include:
- Watchful waiting
- Prostate surgery – There are a variety of surgical options.
- Prostate artery embolization – This is a minimally invasive, non-surgical procedure which may be appropriate — or not — for certain cases.
What is prostate artery embolization?
This minimally invasive, nonsurgical procedure is performed in the interventional radiology suite of the hospital on an outpatient basis. In this procedure, the interventional radiologist will thread a tiny catheter through the artery in the groin to the arteries supplying blood to the prostate gland. The RIA Endovascular physician will then embolize, or cut off the blood flow to, the prostate gland. The decreased blood flow causes the prostate gland to shrink, which helps to decrease the overall size of the prostate gland and relieve symptoms.
What are the benefits of the prostate artery embolization procedure?
Prostate embolization can decrease the lower urinary tract symptoms related to benign prostatic hyperplasia. In several studies, 90% of patients who underwent the prostate artery embolization procedure experienced clinical success.
What are the risks of prostate embolization?
The procedure is still being studied. In one study that looked at immediate success, it was found that 47% of patients had a temporary increase in urinary frequency for 24 hours. Small numbers of patients have developed transient blood in the sperm or diarrhea after the procedure.
Does BPH lead to prostate cancer or increase its risk?
There is no clear evidence that BPH leads to prostate cancer.
Are there conditions I should advise my healthcare provider about before undergoing embolization?
Allergy to IV contrast is a relative contraindication to this procedure.
Does insurance cover this procedure?
Check with your provider. Generally, insurance companies will pay for prostate embolization if they cover prostate surgery, but this is not always the case. For further information, please review your insurance policy and contact your insurance provider. Each plan is different.
After your consultation, if you require insurance pre-certification for the procedure from your insurance provider, RIA Endovascular has a dedicated in-house precertification specialist who will assist in the precertification process.
Please note that preauthorization of any procedure is not a guarantee of payment. Ultimately, your insurance contract is between you and your insurance provider. Ultimately, the responsibility for payment is yours.
Consultation and procedure locations
Your consultation will be held in our offices at 8200 E Belleview Ave, Suite 600, Greenwood Village, 80111. Call 720.493.3406 to schedule your appointment.
The prostate embolization outpatient procedure itself is performed at a local metro Denver hospital.
How do I prepare for the procedure?
Following your consultation, RIA Endovascular will supply you with specific instructions to prepare for the procedure. In general:
- Arrange to have a familiar person as your designated driver.
- Do not take any blood-thinning agents (such as NSAIDS, aspirin, Coumadin, Warfarin) for five days prior to the procedure.
- Do not eat 8 hours before the procedure. You may have clear liquids up to four hours prior to the procedure. It is okay to take morning medicines with a sip of water, unless otherwise advised.
- On your scheduled date, please check in at the hospital registration desk.
What to expect during the prostate embolization? What is the prostate embolization procedure?
Once paperwork is completed, an IV is started to administer medication for “twilight sleep.” This is not a general anesthetic, but rather conscious sedation. A topical anesthetic (a numbing medicine) is then administered just above the hip. After your interventional radiologist makes a small incision, a thin catheter is inserted into the artery and maneuvered, under image guidance, to the region of the prostate gland. Through the catheter, small particles are infused into the prostate gland, choking off the blood supply to the offending arteries. This allows the prostate gland to shrink and relieves the pressure on the urethra. At the end of the procedure, the catheter in the groin is removed. Pressure is applied to the small puncture site, and a small dressing is placed over the area. You will be placed under observation for an hour or two, after which you will be released with further instructions.
Recovering from your procedure
Later that day, you may go home or, if from out of town, to a local hotel or friend’s home. You must have a familiar driver, as you will be both tired and sleepy from the sedation for the procedure. The groin site may be sore but this should clear up within a day or two. We ask that you call our office at 720.493.3406 if you have redness around the incision site, unexpected pain or have a question about how you are feeling.