New Surgery-Free Treatment for Enlarged Prostate
Avoids Sexual Dysfunction
Prostatic artery embolization as effective as popular
TURP surgical method; more than half of senior men have enlarged
prostate; also silodosin a new treatment for prostatitis
May 18, 2011 - A new radiology treatment that
limits blood flowing to a man’s enlarged prostate gland – an ailment
impacting over half of male senior citizens - appears to be as effective
as today’s most popular treatment, but without the risks, such as sexual
dysfunction, urinary incontinence, blood loss and retrograde
ejaculation, noted researchers at the Society of Interventional
Radiology's 36th Annual Scientific Meeting in Chicago last month.
Editorial writers ask if limited benefits are worth
the patient and clinician time and effort;
researchers say 'yes' do to significant, durable improvement in
incontinence and quality of life, - Jan. 12, 2011
"Benign prostatic hyperplasia or BPH is so common
that it's been said that all men will have an enlarged prostate if they
live long enough, said João Martins Pisco, M.D., chief radiologist at
Hospital Pulido Valente and director of interventional radiology at St.
Louis Hospital, both in Lisbon, Portugal.
“I believe that a minimally invasive interventional
radiology treatment—prostatic artery embolization or PAE—will be the
future treatment for benign prostatic hyperplasia or men's noncancerous
enlarged prostates."
Today’s most used therapy is surgical transurethral
resection of the prostate (or TURP).
"While the gold standard treatment for enlarged
prostates has been TURP, minimally invasive prostatic artery
embolization is safe, performed under local anesthesia and has
comparable clinical results—without TURP's limitations and risks," said
Pisco.
The interventional radiologist indicated that PAE
patients experienced symptom improvement comparable to TURP; however,
certain urodynamic results (such as flow rate of the urinary stream) did
not improve as much as with TURP.
Experimental Treatment Offers Relief from Painful
Prostatitis
Silodosin already used to treat pain from enlarged
prostate
May 18, 2011 - New findings show that treatment
with a specific alpha blocker helps reduce symptoms and improve quality
of life for men with chronic prostatitis/chronic pelvic pain syndrome
(CP/CPPS).
The alpha-blocker, known as silodosin, works by
selectively relaxing the muscles in the bladder neck and prostate. The
treatment is already approved in Canada, the United States, the EU and
Japan to treat painful symptoms of another prostate gland condition,
benign prostatic hyperplasia, commonly referred to as an enlarged
prostate.
Despite being the most common form of prostatitis,
CP/CPPS is the most misunderstood and difficult to treat because the
symptoms are very similar to other conditions and requires a significant
degree of testing and screening to identify.
"Antibiotics are commonly used as a treatment, but
are not typically effective, probably because CP/CPPS does not seem to
be caused by a bacterial infection," explains lead researcher Curtis
Nickel, a professor in the Department of Urology, practicing urologist
at Kingston General Hospital, and Canada Research Chair in Urologic Pain
and Inflammation.
CP/CPPS is a debilitating condition characterized
by persistent discomfort in the lower pelvic area including the bladder
area, testicles, and penis. Symptoms can be severe and include painful
and frequent urination and difficult or painful ejaculation. The cause
of the condition is unknown.
In Dr. Nickel's study, approximately 60 per cent of
men reported feeling better after treatment with silodosin versus 30 per
cent of participants who were given a placebo.
The number of patients
who reported feeling better is higher than in a similar study he ran
several years ago that tested the effects of a different alpha blocker.
Dr. Nickel, along with his Prostatitis Research
Group at Kingston General Hospital and Queen's University, has been
studying CP/CPPS for the past two decades. He has been the principal
investigator of over a dozen international clinical trials evaluating
therapies for chronic prostatitis. His research studies are supported by
the Canadian Institute of Health Research, US National Institutes of
Health and industry, including Watson Pharmaceuticals who provided the
support for this particular clinical trial.
Dr. Nickel presented his results yesterday at the
American Urological Association annual meeting in Washington DC. The
study results will appear in an upcoming issue of the Journal of
Urology.
TURP can be performed only on prostates smaller
than 60 cubic centimeters (cc); there is no size limitation for PAE
treatment, said Pisco, who is also a professor at the Faculty of Medical
Sciences, New University of Lisbon.
"The best results are obtained on patients with
prostates larger than 60 cubic centimeters and with very severe
symptoms," he added.
"Pelvic arterial embolization may be the only
feasible and effective treatment for benign prostatic hyperplasia in
those men who cannot have TURP due to the size of their prostate (80+
cubic centimeters) or because it is inadvisable for them to undergo
general anesthesia," said Pisco.
What is BPH?
BPH is not cancer; it is a condition that affects a
man's prostate, a gland found between the bladder and the urethra. As a
man ages, the prostate gland slowly grows bigger (or enlarges) and may
press on the urethra and cause the flow of urine to be slower and less
forceful.
BPH is characterized by urinary frequency, urgency,
passing urine more often (particularly at night), weakened stream and
incomplete bladder emptying.
"Such symptoms can have significant negative impact
in quality of life, leading many men to seek treatment," said Pisco. "We
need innovative technologies, such as prostatic artery embolization, to
continue to improve outcomes and minimize patient discomfort and
morbidity when managing enlarged prostates," he added.
An estimated 19 million men in this country have
symptomatic BPH, (14 million undiagnosed; 2 million diagnosed but
untreated). Statistics show that a small amount of prostate enlargement
is present in many men over age 40, as many as 50 percent experience
symptoms of an enlarged prostate by age 60 and more than 90 percent of
men over the age of 85 will report symptoms.
In this study, 84 men (ranging in ages from 52 to
85) with symptomatic BPH underwent prostatic artery embolization after
failing other medical treatments for at least six months.
The men were followed for more than nine months (on
average), and PAE was found to be technically successful in 98.5 percent
of the patients—with 77 men showing "excellent" improvement, six men
"slight improvement" (but needing no medications) and one experiencing
no improvement (due to receiving an incomplete embolization), Pisco
added.
Two hours after PAE, most men were passing urine
less frequently. It was impossible to embolize both prostate arteries in
the men showing "slight improvement" due to advanced atherosclerosis,
said Pisco.
How the procedure is performed
Prostatic artery embolization is performed by an
interventional radiologist, a physician who is trained to perform this
and other types of embolization and minimally invasive procedures. An
interventional radiologist makes a tiny nick in the skin in the groin
and inserts a micro catheter into the femoral artery.
Using real-time imaging, the physician guides the
catheter through the artery and then releases tiny particles, the size
of grains of sand, into the prostatic arteries that supply blood to the
tumor. These tiny particles block blood flow to the tumor, causing it to
shrink. Following PAE treatment, most men experience no pain to light
pain and leave the hospital four to eight hours after intervention.
"There is no sexual dysfunction following prostatic
artery embolization, and a quarter of our patients report that sexual
function improved after the procedure," added Pisco.
How TURP is performed
BPH can be treated by TURP, a procedure in which a
scope is inserted through the penis and the prostate is removed piece by
piece, or surgery through an abdomen incision (prostatectomy). During
surgery, a man generally undergoes general anesthesia and needs to spend
several days in a hospital. Major complications are frequent, such as
blood loss, severe pain, sexual dysfunction, impotence, retrograde
ejaculation, urinary incontinence, pain, infections and urethral
stricture, said Pisco.
Other treatments for enlarged prostate
Other treatments for enlarged prostrates—besides
prostatic artery embolization, TURP and prostatectomy—include watchful
waiting, drugs (to relax muscles near prostate to ease symptoms or help
shrink the prostate) and other minimally invasive therapies (such as
transurethral needle ablation and laser surgery), which have major
disadvantages, such as providing less effective improvement in symptoms,
poorer durability of symptomatic benefit, and greater risk of continued
catheterization and reoperation.
"Additional research is needed to explain why some
patients improve better than others," said Pisco.
More information about the Society of
Interventional Radiology, interventional radiologists and minimally
invasive treatments can be found online at
www.SIRweb.org.
Links to More Information About Prostate Problems
and Treatments
Prostate Diseases
The prostate is a gland. It helps
make semen, the fluid that contains sperm. The prostate surrounds the
tube that carries urine away from the bladder and out of the body. A
young man's prostate is about the size of a walnut. It slowly grows
larger with age. If it gets too large, it can cause problems. This is
very common after age 50. The older men get, the more likely they are to
have prostate trouble.
Some common problems are
● Prostatitis - an infection,
usually caused by bacteria
● Benign prostatic hyperplasia,
or BPH - an enlarged prostate, which may cause dribbling after urination
or a need to go often, especially at night
● Prostate cancer - a common
cancer that responds best to treatment when detected early
NIH: National Institute of
Diabetes and Digestive and Kidney Diseases
Researchers studied almost 6,000 senior citizens,
suggest patients be informed about the differences and similarities in
expected outcomes, make treatment decisions with an experienced surgeon
-
Feb. 22, 2010
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from heart disease - Feb. 3, 2010
MIRP, especially with robotic assistance, increased from 1% to 40% of radical prostatectomies from 2001 to
2006,despite limited data on outcomes and costs
Sarcosine is better indicator of advancing disease
than traditional prostate specific antigen test (PSA); it is detected in
urine, researchers hopeful simple urine test can be used
