New procedure at University of North Carolina Hospitals in Chapel Hill treats an enlarged prostate using catheter-based treatment performed by vascular interventional radiologists.
Vascular interventional radiologists in the UNC Center for Heart and Vascular Care are some of the first in the nation to use a catheter-based procedure to treat men with an enlarged prostate.
Called prostatic artery embolization (PAE), the new technique is minimally-invasive for patients. It requires no open surgery, meaning less pain, no hospital admission, and for many patients, an almost immediate improvement in their symptoms.
An enlarged prostate, or benign prostatic hyperplasia (BPH), is the most common noncancerous prostate problem, occurring in most men by the time they reach their 60s, according to Charles Burke, MD, Associate Professor, Radiology, and Division Chief, Vascular Interventional Radiology (VIR). (pictured at right)
The PAE treatment is performed through an artery in the upper thigh, similar to cardiac catheterization, without requiring an incision. Using x-ray, a catheter is guided to the artery that supplies blood to the prostate, and tiny beads are injected that temporarily block the blood flow.
By temporarily stemming blood flow to the prostate, it begins to shrink and soften, relieving symptoms. Symptoms of BPH can include slow, interrupted, or weak urinary stream; urgency with leaking or dribbling; and frequent urination, especially at night.
There are a few places in the U.S. that are doing the PAE procedure, but not many, says Dr. Burke.
“It is a brand new procedure in the U.S., but the more long-term results that have been reported out of Europe show that it is effective without risk of sexual side effects,” explains Dr. Burke. “Additionally, it should be noted that although it is a new procedure, the skills involved are not new to Interventional Radiology. We regularly use very similar techniques and equipment to treat uterine fibroids. Given the available data, we are dedicated to bringing this procedure to patients at UNC.”
“I am not aware of anyone in North Carolina who is doing this procedure,” adds Dr. Burke.
Current treatments for BPH include medical therapy or transurethral resection of the prostate (TURP), which removes the enlarged prostate piece by piece. PAE is currently only indicated for men who are experiencing symptoms despite taking medication.
At the 2013 Society for Interventional Radiology (SIR) annual meeting, early findings from the first prospective U.S. trial of PAE were presented by Sandeep Bagla, MD, from Inova Alexandria Hospital in Virginia. Dr. Bagla indicated technical success in 17 of 18 men (94%) who underwent PAE and clinical success in 14 (93%) of the 17 patients, with none suffering any major complications, such as impotence, leaking urine, infection, or post-procedural pain.
The first patient to undergo PAE at UNC was Frederick Sims, who had the procedure in May 2013 after being admitted to UNC Hospitals for urosepsis, septic poisoning stemming from a serious urinary tract infection.
Mr. Sims had a history of urinary tract infections due to his BPH and had a 24-hour a day catheter in place to assist with the elimination of urine.
Frederick Sims’ son, Greg, explains, “My father had a debilitating stroke more than five years ago, and my sister and I found a constant care facility for him. The facility told us that he was ‘always in the bathroom’ so they convinced us that he needed a catheter.
Eventually, the combination of having a long term catheter and the large size of Mr. Sims’ prostate made it impossible for him to urinate without it. The need to have a catheter present at all times led to recurrent urinary tract infections.
“When my father was admitted to UNC Hospitals for urosepsis, Dr. Ari Isaacson (from VIR) told us our dad was a candidate for the prostatic artery embolization to treat his BPH. He said it could possibly eliminate the need for his catheters,” says Greg. “Dr. Isaacson is one of the nicest people I’ve ever met, and he made it easy for us. We were willing to try anything at this point.”
Dr. Burke and Ari Isaacson, MD, Assistant Professor in the Division of Vascular Interventional Radiology (pictured at right), performed the prostatic artery embolization, and at first, it appeared not to work.
“Dr. Isaacson told us it could take months to show results, but what did we have to lose? Our dad’s quality of life was so poor that this seemed like the best option,” explains Greg.
Six weeks after the procedure, Mr. Sims’ care facility called Greg. It appeared that Mr. Sims was now able to urinate without the catheter. After a short trial to ensure that results were not temporary, it was found that the PAE had worked, and Mr. Sims’ no longer required a urinary catheter.
“The procedure worked!” exclaims Greg. “Dr. Issacson and his team are amazing doctors! UNC Hospitals is filled with such caring people. We can’t thank them enough for helping our father.”
Recently, Mr. Sims experienced additional health complications unrelated to his PAE procedure, and had to be re-catheterized. Greg adds, “I know the PAE worked because my dad’s infections are down and his pain is down. To our family, it is amazing!”
The two leading studies on PAE for treating BPH come from Brazil and Portugal.
At the Society of Interventional Radiology (SIR) 2012 annual meeting, Francisco Cesar Carnevale, MD, PhD, a professor and chief of interventional radiology at the University of São Paulo Medical School in Brazil, said that results of a four-year study suggest that PAE is “safe, effective, and has a low rate of complications.”
Researchers from the New University of Lisbon in Portugal, led by Joao Martins Pisco, MD, have reported similar results. In January 2013, Dr. Pisco reported that 255 men treated with PAE with follow up to three years showed improvement of symptoms similar to the results achieved by the current gold standard treatment. Most interestingly, none of the men reported worsening sexual performance as a result of the procedure, and even half of the men reported improved sexual performance.
In a news release from the Radiological Society of North America (RSNA), Dr. Carnavale said, “Only experienced physicians trained in interventional radiology techniques as well as someone who has a strong understanding of pelvic vascular anatomy should perform the procedure.”
Dr. Burke has trained and worked at UNC since 1997, now serving as the VIR Division Chief. Recently, he was inducted as a Fellow in the Society of Interventional Radiology (SIR). This honor, achieved by fewer than 10 percent of SIR members, goes to members who have been recognized as a leading contributor in educational, investigational, organizational or professional aspects of interventional radiology. In 2003, 2006 and 2007, Dr. Burke was named “America’s Top Radiologist” by Consumers Research Council of America.
Dr. Isaacson trained under Dr. Burke as a Fellow at UNC. His interests include vascular imaging in the setting of renal disease, prostatic artery embolization, medical student and resident education and utilization of advanced procedural imaging techniques.