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26 March 2012
Radiology breakthrough in treating enlarged prostate
by George Atkinson

Prostatic artery embolization could relieve the debilitating symptoms caused by an enlarged prostate without the risk of impotence and urinary incontinence that surgery entails, says one of the medicos who pioneered the new treatment. Francisco Cesar Carnevale, chief of interventional radiology at the University of São Paulo in Brazil, detailed his work at the Society of Interventional Radiology's 37th Annual Scientific Meeting in San Francisco.

The new findings provide hope for those who might not be candidates for transurethral resection of the prostate (TURP) and may allow them to avoid serious complications that sometime result from surgery. "More than a quarter of a million men undergo surgery for an enlarged prostate every year, at an estimated annual costs of over $1 billion per year because current therapies including medication just aren't working for them," commented Ziv J Haskal, a radiologist who traveled to Brazil to learn about the treatment and to begin the process that may bring this treatment to the United States. "I saw firsthand how these men responded to treatment. With the possibility of faster recovery - on an outpatient basis - and with no bladder catheters, reduced symptoms, improved urination and fewer potential side effects, prostatic artery embolization could signal a bold new change in accepted prostate therapy."

Interventional radiologists have used embolization, where a catheter is used to deliver tiny beads to block blood flow to a target area, for many years to treat uterine fibroids with very few complications. "Applying this same principal to the prostate by embolizing or blocking the prostatic arteries, thereby reducing its size and releasing the pressure on the urethra so that a man is then able to void normally, seemed like a natural progression," explained Carnevale.

The embolization technique uses a tiny one-millimeter diameter microcatheter that is threaded into the prostate arteries under local anesthesia.

Carnevale's study looked at the results from men who suffered with acute urinary retention due to an enlarged prostate and who received embolization treatment. "After the treatment, we assessed quality of life and evaluated how well the urinary system was working. Clinical success was seen in 91 percent of those treated and technical success was evident in 75 percent of those treated," Carnevale noted.

He added that overall clinical improvement in lower urinary tract symptoms at the one-year mark was observed and corroborated by all patients. All of those treated also reported a high degree of satisfaction and increased quality of life after the treatment.

"Although these preliminary results are very promising for American men, it must be noted that prostate artery embolization is an extremely advanced embolization procedure requiring rigorous training and a detailed knowledge of the prostate anatomy and surrounding vessels," commented James B. Spies, professor and chair of the radiology department at Georgetown University Medical Center. "I expect there will be considerable additional study - including multicenter clinical trials - that explore the safety, efficacy and durability of this procedure before it will become broadly available in clinical practice."

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Source: Society of Interventional Radiology

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