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Enlarged prostate: new procedure shows promise in reducing nighttime waking

New research suggests a technique that blocks blood flow to the prostate shows promise in the treatment of enlarged prostate. An analysis of men with enlarged prostates and lower urinary tract symptoms who underwent the procedure found many of them experienced a reduction in night visits to the bathroom.

The study on prostatic artery embolization (PAE) and its effectiveness in reducing nocturia – waking in the night because of a need to urinate – featured at the Society of Interventional Radiology meeting (SIR2016) in Vancouver, Canada, April 2-7, 2016.

Lead researcher Dr. Sandeep Bagla, an interventional radiologist at the Vascular Institute of Virginia, says that the lack of a full night’s sleep due to waking in the night with an urgent need to visit the bathroom can significantly affect quality of life, and explains:

«For many men, the cause of their discomfort is an enlarged prostate and these results show men can live a more normal life once they’ve undergone PAE to address this condition.»

Over half of men over the age of 50 have benign prostatic hyperplasia (BPH), or an enlarged prostate gland. Excess cell growth causes the gland to swell and squeeze the urethra that it surrounds. This interferes with urine flow. In very severe cases, affected men cannot pass urine at all.

BPH is not life-threatening, but it causes unpleasant and sometimes aggravating symptoms, such as weak urine flow, inability to empty the bladder completely and frequent urination at night. If untreated, the condition can lead to bladder stones, poor kidney function and infection.

What is PAE?

PAE is a relatively new interventional radiology treatment for BPH. It is not as invasive as other treatments that use surgery; it is usually performed on an outpatient basis, allowing many men to go home the same day.

The treatment involves inserting a catheter into the femoral artery and guiding it to the prostate artery on both sides of the enlarged gland. The catheter delivers tiny plastic beads into the artery to block blood flow, causing the prostate to shrink.

Dr. Bagla says interventional radiologists are probably the best specialists for carrying out PAE because they know all about arteries, how to use microcatheters and have experience of carrying out other types of embolization.

PAE is not yet approved by the Food and Drug Administration (FDA), but the agency is working with interventional radiologists, and it is thought the technique could become part of standard care for treating BPH within the next 5 years or so.

PAE reduced urinary symptoms and improved quality of life

For the retrospective study, the team analyzed data on 68 men with BHP and lower urinary tract symptoms who underwent PAE.

Before treatment, the men filled in a symptom index about the severity of their urinary symptoms, with scores ranging from 0 for no symptoms to 35 for very severe symptoms. They also completed quality-of-life surveys and were asked how often they had to urinate at night.

Before undergoing PAE, the patients’ average symptom index score was 23.9, their average quality-of-life score was 4.8 and the average number of times they woke at night to urinate was 3.3.

Forty-six of the men were caught up with 1 month after treatment, and 38 of the men after 3 months, at which points they filled in the questionnaires again.

The results at 1 month after treatment showed reductions in nighttime waking to urinate, with 25 of the 46 (54.4%) reporting an absolute reduction of 0.85 episodes per night.

Also, the 46 patients showed an average 10-point reduction in their symptom severity index, and their quality-of-life score went up by 2.1, suggesting their urinary symptoms were less bothersome and they were experiencing a better quality of life.

The results at 3 months after treatment showed further reductions in nighttime waking to urinate, with an average reduction of 1.4 episodes per night. And there was a 13.4 reduction in the symptom severity scores and a 2.8 improvement in the quality-of-life scores.

The researchers conclude that these improvements put PAE on a par with surgical procedures such as TURP and PVP, both of which have higher reported complications than PAE.

TURP (transurethral resection of the prostate) involves going through the urethra to cut away sections of the prostate. PVP (photoselective vaporization of the prostate) also goes through the urethra and uses a laser to burn away prostate tissue.

Dr. Bagla says that many of his PAE patients tell him that sleep deprivation takes a toll and not having to go to the bathroom so often in the night has improved their daily lives in many ways, including work performance. He adds:

«Anecdotally, patients who show signs of a better quality of life 3 months after the treatment appear to continue their progress 2 or 3 years after undergoing PAE.»

However, he warns that while this study shows PAE reduces nighttime waking to urinate for men with BPH and lower urinary tract symptoms, it may not completely eliminate the symptom. He urges patients to speak to their health care professionals to establish what else they may need.

Other studies have also suggested PAE shows promise for the treatment of enlarged prostate. What is now needed, say the researchers, are more high-quality clinical studies that follow larger groups over a longer period and compare PAE with surgical techniques.

Meanwhile, Medical News Today learned how another study presented at a recent urology meeting suggests testing for non-coding RNA molecules in a man’s urine may be a more accurate and reliable way to detect prostate cancer than using current biomarkers like PSA and PCA3.

Written by Catharine Paddock PhD