Men: It’s time to talk about your prostate

September is National Prostate Health Month, so it’s a good time to talk about prostate issues and how they can affect men’s health.

One prostate issue that most men will experience in their lifetime is called benign prostatic hyperplasia (BPH), more commonly known as an “enlarged prostate.” half of all men between 51 and 60 years of age and up to 90% of men older than 80¹ will experience this condition. Getting up repeatedly in the middle of the night with an urgent need to urinate is one of the symptoms of BPH, as well as difficulty urinating, a weak urine stream and the inability to start urinating or completely empty the bladder.

What is happening here? The prostate grows larger over time… it’s a normal part of aging. When it does, it presses against the urethra and bladder. For some, it can grow very large and cause frequent or difficulty urinating, incontinence, reduced sex drive and even erectile dysfunction. One study showed that 95% of men with moderate BPH are unhappy and do not wish to spend the rest of their lives suffering from these symptoms.²

In the past, men had one treatment option for BPH—a surgery called transurethral resection of the prostate (TURP). During this surgery, a special instrument is inserted through the tip of the penis and into the urethra, the tube that carries urine from the bladder. The device is then advanced to the prostate gland where it is used to remove a portion of the prostate gland. Approximately 150,000 men have TURP surgery every year.

However, TURP is a major surgery, with serious risks. Complications are also surprisingly common, and include bladder injury, inflammation, infection, bleeding and a loss of erections. 65 out of 100 men who have the surgery experience retrograde ejaculation—an unfortunate condition where semen goes into the bladder and not out of the penis. Another complication of TURP is painful or difficult urination, which is one of the problems the surgery is intended to alleviate!

You might ask yourself, are the risks of TURP surgery worth it? At one point, they may have been, but today there is another and far more practical option for men.

For men with moderate to severe BPH symptoms, the FDA-approved prostate artery embolization (PAE) procedure is a highly effective and less invasive alternative to TURP surgery. PAE is performed by an interventional radiologist who, using imaging guidance, inserts a tiny catheter into an artery in the patient’s upper thigh or wrist, and then guides it through the body’s vascular system to the arteries supplying blood to the prostate. Tiny spherical “beads” are released through the catheter and into the arteries, partially blocking blood flow to the gland. With reduced blood flow, the prostate shrinks and symptoms are relieved.

PAE is an outpatient procedure performed at National Vascular Physicians centers in National Harbor, MD and Roanoke, VA that requires no general anesthesia. It has a high success rate, and when compared with TURP surgery, PAE offers a faster recovery, fewer complications and a lower risk of sexual side effects, such as erectile dysfunction and retrograde ejaculation. Medium- and long-term results show that PAE achieved clinical success rates of 81.9% and 76.3% respectively, with no urinary incontinence or sexual dysfunction reported.

In recent years, additional “less invasive” procedures have been approved for treating enlarged prostate, but when you compare the pros and cons, you’ll find that PAE may be your best option.

1. Barry M, Roehrborn C. Management of benign prostatic hyperplasia. Annu Rev Med. 1997;48:77-189
2. Bertaccini, A., Vassallo, F., Martino, F., Luzzi, L., Rossetti, S., Di Silverio, F., et. Al. Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH. Eur Urol. 2001;40 (Suppl 1):16.
3. Cardiovasc Intervent Radiol. 2017 Nov;40(11):1694-1697. doi: 10.1007/s00270-017-1700-7. Epub 2017 May 30.