PAE report from the UK

Patients report from a UK newspaper today.

About four years ago, I began waking in the night

needing the loo but often struggled to urinate. I looked up my symptoms and

read that urine flow can be affected by an enlarged prostate. I went to see my

GP, who examined me and confirmed that this was, in fact, the case. I also had

a blood test to check my PSA (a protein made in the prostate gland) level, to

see if I might have prostate cancer, and this came back as 12.4 — a very high

score. I was referred to a urologist and he diagnosed prostatitis, which

is inflammation of the prostate gland. The prostate sits around the urethra,

which removes urine from the body, and that is why my urine flow had been

affected.I was told I didn’t need treatment and was relieved it wasn’t cancer.

I was still getting up in the night now and then, but I could live with it. Then,

one morning in March last year, I felt the urge to go to the loo, but couldn’t.

I kept trying, but nothing. So I panicked. I called my GP, who told me to come

in. The GP inserted a catheter as a temporary fix — which emptied into a bag

strapped to my leg. She also referred me back to hospital. Wearing the catheter was painful and I was

constantly conscious of how I moved, worrying about leaks. I avoided

socialising and needed time off work. At my urology appointment a few weeks

later, it was confirmed I had benign prostatic hyperplasia (BPH) — where the

prostate enlarges. I was advised I might need surgery, but there was a

year-long wait. Researching my options, I came across prostate artery

embolisation (PAE), a less invasive technique, where tiny beads are used to

block the blood supply to the prostate, shrinking it. I had read of men left incontinent or

impotent after traditional surgery, and PAE appeared to have fewer

side-effects. I asked my specialist and he said he could fit me in for PAE

within three weeks. During the procedure, at the Churchill Hospital in Oxford,

gel beads were inserted into the arteries that supply the prostate through a

wire in my right groin. It is usually done under local anaesthetic, but I

didn’t want to be awake for it, so I asked for a general anaesthetic. I left

the hospital a couple of hours later with a catheter fitted. I felt some

discomfort on the first night, so I took painkillers, but a day later I didn’t

need to take any more drugs. After two weeks, the catheter was removed and I

could urinate normally as the inflammation had reduced so much. I am delighted

with the results — I can live a normal life again.

Doctors report:

Dr Charles Tapping is a consultant interventional

radiologist at Oxford University Hospitals Foundation Trust. Benign prostatic

hyperplasia affects around 40 per cent of men over 50; and 80 per cent of those

aged 80 or over. The prostate is a walnut-sized gland that lies under the

bladder and surrounds the urethra, the tube that passes urine. If the prostate

grows, it can put pressure on the bladder and urethra, inducing a constant urge

to pass water. BPH can be down to a family history or hormonal imbalance. Risk

factors include obesity, heart disease and diabetes. Like many men I see, John

had done a lot of research, and had discovered prostate artery embolisation.

This is a non-surgical way of blocking the arteries supplying blood to the

prostate, which carries the hormones which encourage the excess growth. From

2014, I have been involved in trials of the procedure, with great success.

Approximately 80 per cent of patients found relief, with minimal side-effects In

April last year, NICE advised that PAE is safe and effective. An operation

called transurethral resection of the prostate (TURP) is the standard treatment

for BPH. This involves cutting away part of the prostate. But it carries a risk

of damage to the muscles or nerves surrounding the bladder, leading to

incontinence or impotence. PAE is usually done under local anaesthetic. We

inject dye to see the arteries supplying the prostate with an X-ray camera. The

hundreds of microscopic gel beads we use come mixed in 12ml of fluid in a

syringe. We feed in a catheter (a long, thin tube) via an artery at the top of

the all the way to the prostate arteries, then inject the beads through the

catheter to block the arteries. A CT scanner hooked to a screen helps us see

the beads have gone to the right place. The procedure takes an hour to an

hour-and-a-half, and men can go home the same day. In the following weeks, the

prostate shrinks back to a normal size. The beads remain there for life. Almost

five years of evidence points towards this being the safest way to shrink

enlarged prostates, and I believe the long-term results will be good.

The procedure costs

£3,200 to the NHS, and £5,000 privately.

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