Friday, February 28, 2014

Prostatic Artery Embolization for Benign Prostatic Hyperplasia

From "Prostatic Artery Embolization Promising
for Treating Enlarged Prostate",
Radiological Society of North America
Prostatic Artery Embolization (PAE) was first described in the 1970's as a salvage approach for intractable prostatic hemorrhage.  As a secondary effect, patients embolized for bleeding experienced improvement in their lower urinary tract symptoms (LUTS) and objective reduction in prostate volume.[1]

Significant literature exists describing prostatic arterial anatomy and variants.  The preclinical research defining this anatomy was done in a porcine model.[2]  The first report of PAE for benign prostatic hyperplasia (BPH) in the peer-reviewed literature was by Carnevale and colleagues in 2010.[3]  In this initial case series, two patients had significant reductions in prostate volume and improvement in LUTS.

Since then, a number of case series and small studies demonstrate improvements in a number of parameters related to BPH.  However, none of these studies are randomized or controlled, they are often single-institution and may omit one or more meaningful outcome measures.

Pisco and colleagues reported the outcomes of 15 consecutive patients undergoing PAE. [4] Over a median follow-up of 8 months, they demonstrated an improvement in symptoms (mean IPSS decrease 6.5), improved urine flow (mean Qmax increase 3.85mL/s) and decreased prostate volume (mean volume reduction 28.9mL).  Importantly, there were no changes in PSA or erectile function indicating that PAE did not affect the cavernous arteries or nerves that control erections.  Only one patient experienced a complication (bladder wall ischemia) that did require surgical correction.

The same group has now reported (up to) 2 year outcomes for 103 patients undergoing PAE.[5]  They reported promising operative and perioperative outcomes including little reported pain (average visual analog pain score 1.6), a mean procedure time of 83 minutes, mean fluoroscopy time of 24 minutes, improvement in LUTS (mean IPSS decline 13.5 at 2 years) and urine flow rates (mean increase in Qmax 5.7mL/s).  There was no significant change in PSA or prostate volume at the 2 year mark.  

Given the strengths and shortcomings in the data regarding PAE, there is a fair amount of enthusiasm and skepticism for PAE in the urological community.  In a recent editorial in the Journal of Urology, Kevin T. McVary (Associate Editor), Professor and Chair, Division of Urology of Southern Illinois University said,
"If PAE has merit for our patients there will be no avoiding the truth...  the best way to expose it with as little risk to our patients and society is through a properly performed randomized clinical trial."

Stephen Schatz, MD
Johns Hopkins is one of 12 sites worldwide participating in a prospective, randomized trial comparing PAE to traditional transurethral resection of the prostate (TURP) for BPH.  Stephen Schatz, MD, Assistant Professor of Urology has teamed up with Kelvin Hong, MD and Mark Lessne, MD of the Deparment of Vascular and Interventional Radiology to administer the study.  The primary endpoint is the International Prostate Symptom Score (IPSS) at 12 months; and secondary endpoints will include urine flow (Qmax), post void residual, detrusor pressure, erectile function, prostate volume (by MRI) and PSA measurements.

Men interested in participating must:

  • be between 50 and 79 years of age
  • have an IPSS > 13
  • have a prostate volume 50-80 grams
  • have failed medical therapy
  • be a candidate for TURP
  • have no suspicion of prostate or bladder cancer 

Interested patients can call the Brady Urological Institute Clinic 410 955 6100 for an appointment with Dr. Schatz or speak with Elizabeth Fabian, the study coordinator.

This blog was written by Stephen Schatz, MD.


[1] DeMeritt JS, et.al. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol. 2000;11(6):767–770
[2] Sun F, Sánchez FM, Crisóstomo V, et al. Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment—preliminary study in pigs. Radiology. 2008;246(3):783–789.
[3] Carnevale FC1, Antunes AA, da Motta Leal Filho JM, de Oliveira Cerri LM, Baroni RH, Marcelino AS, Freire GC, Moreira AM, Srougi M, Cerri GG.  Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients.  Cardiovasc Intervent Radiol. 2010 Apr;33(2):355-61. doi: 10.1007/s00270-009-9727-z. Epub 2009 Nov 12.
[4] Pisco JM, Pinheiro LC, Bilhim T, Duarte M, Mendes JR, Oliveira AG.  Prostatic arterial embolization to treat benign prostatic hyperplasia.  J Vasc Interv Radiol. 2011 Jan;22(1):11-9
[5] Rio Tinto H, et.al., Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia: Short and Medium Follow-up.  Tech Vasc Interv Radiol. 2012 Dec;15(4):290-3.

8 comments:

  1. This comment has been removed by a blog administrator.

    ReplyDelete
  2. artikel obat penyumbatan pembuluh darah menjelaskan tentang Apa yang terjadi jika pembuluh darah tersumbat? Arteri adalah pembuluh darah yang membawa darah kaya oksigen ke seluruh tubuh Anda. Arteri membawa darah mulai dari kepala, otak sampai ke ujung jari kaki anda. Arteri yang sehat memiliki dinding bagian dalam halus berguna untuk mengalirkan darah dengan mudah. apa yang akan terjadi bila terdapat penyempitan pembuluh darah yang disebabkan oleh plak arteri?

    ReplyDelete
  3. Công thức làm kem trộn trắng da toàn thânVới phương pháp làm trắng da tự nhiên này, bạn sẽ không còn lo ngại làn da đen xỉn màu nữa, đồng thời đảm bảo an toàn cho da.
    Cách làm kem trộn trắng da toàn thânCách thực hiện: Chuẩn bị ½ chén cám gạo, ½ quả chanh và 4 thìa sữa tươi không đường.
    Bà bầu nên ăn những gì trong 3 tháng đầu?Giai đoạn đầu này nếu chúng ta cung cấp không đủ chất dinh dưỡng, ăn uống sơ sài thì thai nhi sẽ rất dể bị chứng không phát triển dẩn đến thiểu năng. Nào chúng ta hãy cùng tìm hiểu nhé!
    bà bầu ăn ốc có sao không?Trong ốc chứa rất nhiều chất dinh dưỡng, giúp bồ bổ cơ thể, tuần hoàn máu.
    Bà bầu ăn ổi có sao không?Bà bầu mang thai thường có xu hướng thèm ăn trái cây, có người thèm chua cũng có ngừoi thèm ngọt.
    bà bầu ăn trứng vịt lộn có sao không?Thời điểm nên ăn: Các chuyên gia dinh dưỡng khuyên nên ăn trứng vịt lộn vào buổi sáng, tránh ăn vào buổi tối vì đây là món ăn khó tiêu, nếu ăn trứng vào buổi tối xong
    Bà bầu ăn thịt chó có tốt không?Chó là loài vật rất thân thiết với con ngừoi. Vừa là bạn thân vừa là thú cưng có thể giữ nhà.
    Bà bầu ăn măng có tốt không?Trong măng tươi, có hàm lượng Cyanide – là một gốc Acid (-CN) mà hợp chất của nó bao gồm các muối hoặc Acid,
    Bà bầu uống sữa đậu nành nhiều có tốt không?Sữa đậu nành là một loại thức uồng rất tốt cho sức khoẻ. Trong đậu nành có các acid béo thiết yếu, protein, khoáng chất, chất xơ và vitamin.
    Bà bầu nên nghe nhạc gì để con thông minh?Trong thời gian mang thai các bà mẹ thường tất bậc chuẩn bị tất cả mọi thứ để chuẩn bị chào đón đứa con của mình chào đời.
    Bà bầu 5 tháng nên ăn gì?Trong quá trình mang thai, việc cung cấp đủ chuất dinh dưỡng cho mẹ và bé là điều rất quan trọng.

    ReplyDelete
  4. I always advocate men take enlarged prostate seriously. I learnt the hard way, but I am glad herbal medicine came through for me. Years ago, I observed some urinary issues. It started with frequent urge to urinate, delay in initiating urination, and moved to a slow urinary flow. Initially I did not take it seriously. I was 66 years and didn’t know BPH would come that early. Other symptoms followed and it became a concern. What I hated was getting up at night to urinate. These continued till I did a scan which revealed my prostate was enlarged to 70grams. It was scary! I took medications as treatment for years with no cure, coupled with side effects I had. It became depressing, and affected my sexual life. In order to get help, I spent time and searched for a natural cure. I listened to YouTube videos on BPH and read blogs to find a way out. About 2 years ago, I stumbled on a cure story of enlarged prostate shared on a blog, I followed the link shared, and got to read about Dr. Mohan natural medicine. That was the beginning of my freedom! I finished my treatment with Dr. Mohan herbal medicine in the shortest period of time. Scan after treatment revealed  normalized prostate size with all symptoms gone! I wish I had met Dr. Mohan early I would not have experienced pain and discomfort for 8 years. Dr. Mohan Herbal medicine gave me the freedom which allopathic medications could not for many years. Read about Dr. Mohan herbal medicine and get in touch at http://naturalcureforenlargeprostate.blogspot.com

    ReplyDelete
  5. We tried to get pregnant for a few years in a local clinic. There were no results. We've tried everything possible but nothing. We were recommended to use donor eggs. I know we have to try herbal made medicine. I was terrified. I didn't know how to go about it and where to begin my search. When my friend recommended me to Dr Itua herbal medicine in Western African. I thought she was joking. I knew nothing about that country and I was afraid  with shame I must say I thought it was a little bit...wild? Anyway she convinced me to at least check it out. I've done the research and thought that maybe this really is a good idea. Dr Itua has reasonable prices. Also it has high rates of successful treatments. Plus it uses Natural Herbs. Well I should say I was convinced. My Husband gave it a try and now we can say it was the best decision in our lives. We were trying for so long to have a child and suddenly it all looked so simple. The doctors and staff were so confident and hopeful they projected those feelings on me too. I am so happy to be a mother and eternally thankful to Dr Itua  and Lori My Dear Friend. Don’t be afraid and just do it! Try Dr itua herbal medicine today and sees different in every situation.Dr Itua Contact Info...Whatsapp+2348149277967/drituaherbalcenter@gmail.com Dr Itua have cure for the following diseases.All types of cancer,Liver/Kidney inflammatory,Fibroid,Infertility.Diabetes,Herpes Virus,Diabetis,Bladder cancer,Brain cancer,Esophageal cancer,Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,Hodgkin lymphoma. Intestinal cancer,Kidney cancer,Leukemia,Liver cancer,Lung cancer,Melanoma,Mesothelioma,Multiple myeloma,Neuroendocrine tumors. Non-Hodgkin lymphoma,Oral cancer,Ovarian cancer,Sinus cancer,Skin cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer. Testicular cancer,Throat cancer,Thyroid Cancer,Uterine cancer,Vaginal cancer,Vulvar cancerBipolar Disorder, Bladder Cancer,Colorectal Cancer,HPV,Breast Cancer,Anal cancer.Appendix cancer.,Kidney Cancer,Prostate Cancer,Glaucoma., Cataracts,Macular degeneration,Adrenal cancer.Bile duct cancer,Bone cancer.Cardiovascular disease,Lung disease.Enlarged prostate,OsteoporosisAlzheimer's disease,Brain cancer.Dementia.Weak Erection,Love Spell,Leukemia,Fribroid,Infertility,Parkinson's disease,Inflammatory bowel disease ,Fibromyalgia.

    ReplyDelete
  6. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.

    ReplyDelete