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Prostate therapy without surgery: Thousands of men to benefit from new technique that uses plastic beads to block blood supply and shrink the enlarged gland
PUBLISHED: 05:00 BST, 8 March 2017 | UPDATED: 08:19 BST, 8 March 2017
Tens of thousands of men could benefit from a breakthrough prostate treatment announced today.
The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation.
A successful trial in Portugal is being followed up in Britain, with results due back later this year. If successful it could be rolled out for routine use on the NHS.
Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it.
As well as being painful and invasive, the operation can cause loss of sexual function and even incontinence.
+3
The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation
Last night, researchers said they expected the new technique – prostate artery embolisation – to largely replace surgery as the standard treatment.
An enlarged prostate presses on the bladder, while also blocking the urethra. This means sufferers need to make repeated night-time trips to the toilet, often to find they cannot urinate at all.
This can lead to a build-up of toxins that cause severe kidney problems. The bead technique has been tested on 1,000 middle-aged men in Portugal.
Joao Martins Pisco, who led the study at St Louis Hospital in Lisbon, said: 'Within five years I think this will replace surgery as the standard treatment.
'Prostate artery embolisation gives men a treatment option that is less invasive than other therapies and allows them to return to their normal lives sooner.
Time and time again, I see patients who are relieved to find out about prostate artery embolisation because they are not able to tolerate medications due to their side effects.
'These men also don't want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to prostate artery embolisation, which is generally performed under local anaesthesia and on an outpatient basis.'
The Portuguese team, which will present its findings at the Society of Interventional Radiology in Washington DC today, concluded the procedure is as effective as surgery and the benefits may last as long.
Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it
Only two patients in the seven-year trial had clinical side effects.
Performed under local anaesthetic, the procedure involves injecting hundreds of 0.2mm plastic beads into an artery in the groin.
The beads are directed with a thin tube into the blood vessels that flow to the prostate, blocking blood supply to the enlarged gland so that it shrinks.
Dr Pisco added: 'I have had nine babies born to men who were able to continue their sex lives after having the treatment.'
His team saw a 89 per cent success rate six months after surgery, 82 per cent success up to three years, and 78 per cent beyond three years.
Two hundred patients in Southampton General, Guy's Hospital in London and 16 other clinics are involved in the British trial, which is part-funded by the clinical watchdog NICE.
Dr Nigel Hacking, who is leading the study, said: 'It is very encouraging. I am always cautious about new techniques but this procedure seems to be showing promise and it seems to be safe.'
Louise de Winter of the Urology Foundation said: 'This research is very exciting.
'As the population ages these problems are going to get even more acute.'
An estimated 45,000 men undergo surgery for enlarged prostates every year in the UK.
Dr Pisco claims most of these could be replaced by prostate artery embolisation – although others say the less invasive procedure is not be suitable for all men, and many will have to continue to have surgery.
Two hundred patients in Southampton General (pictured) Guy's Hospital in London and 16 other clinics are involved in the British trial
Dr Hacking said that in his own experience, roughly 40 per cent of patients who have embolisation later have to undergo operations.
But having initial embolisation may enable them to delay that operation while retaining sexual function, and this usually means that when they do come to have an operation it is less invasive and there is a lower risk of side effects.
'Even if they do need to go back and have surgery it's a smaller operation,' he said.
Dr Hacking said it was unlikely the procedure will completely replace surgery, because it requires a highly trained interventional radiologist.
'It is a fiddly procedure and it would be potentially dangerous for someone without the skills to do it,' he said.
'But I think it may give men another option alongside surgery.'
Surgery, conducted either with a hot wire or lasers, have a high success rate - but they come with side effects which can include loss of sexual function, bleeding and incontinence.
The symptoms of enlarged prostate include a frequent need to urinate, but also difficulty starting to urinate and difficulty fully emptying a bladder.
These symptoms, however, also might be a sign of prostate cancer, so anyone in this way should be seen by a urologist.
British NHS has greenlighted the Prostatic Artery Embolization treatment:
Breakthrough prostate treatment rolled out on the NHS | Daily Mail Online (2018)
Pioneering prostate treatment for tens of thousands of men gets NHS green light (2018)
The studies:
https://www.researchgate.net/public...zation_for_Prostate_Cancer-Initial_Experience
https://www.researchgate.net/publication/321339938_Surgical_Treatment_Prostate_Artery_Embolization
https://www.researchgate.net/public...Embolization_for_Benign_Prostatic_Hyperplasia
https://www.researchgate.net/public...Prostatic_Hyperplasia_Results_in_630_Patients
See here for the studies: https://www.researchgate.net/scientific-contributions/46532827_Joao_Martins_Pisco
More sources:
Nonsurgical treatment for enlarged prostate remains effective for years
We have successful treatment using selective occlusion of veins on the one side:
Reversal Of Benign Prostate Hyperplasia By Selective Occlusion Of Impaired Venous Drainage In Males
And successful treatment using embolization of arteries on the other side:
Surgical Treatment: Prostate Artery Embolization (in a 1,000 patients trial)
Something tells me that the prostatic venous plexus and the prostatic venous drainage system have something to do with this...
From other topic What Would You Suggest For BPH Prostate Trouble?:
Prostatic venous plexus - Wikipedia
Even if there is no varicocele present, theoretically there could still be abnormalities of the prostatic venous plexus which cause proliferative problems with the prostate.
(retrograde flow of hormone-rich blood, etc.)
Finally I've found a good anatomical picture which shows all the relevant veins in a clear matter.
Source: Neurologic Complications of Prostate Cancer
Hormones cause varicose veins. Varicose veins cause back flow, bypassing of the blood, stagnant blood, leakiness of the veins etcetera. Where are hormones most frequently present? The pelvic area. So it wouldn't be such a strange idea that varicose veins cause BPH. Varicose veins that can't be seen, too. Like those of the prostatic venous plexus.
"3. The arteriosclerotic and varicose vein theory. With arteriosclerosis, or hardening of the arteries, there is a decrease in the caliber or gauge of the blood vessels to the prostate gland, which, receiving a deficient supply of blood, is thus not properly nourished. If varicose veins are present, venous stasis may be combined with deficient nourishment to bring on enlargement of the prostate.
Varicose veins of the urinary bladder are often noted in association with prostatic hypertrophy. These veins drain blood from the vesicoprostatic venous plexus. Bleeding from the prostatic capsule following prostatectomy is most often from enlarged veins. In the area of the prostatic capsule, a tight cover with a sphincter at each end, lymph and venous blood have difficulty circulating even under normal conditions. If the physiology is disturbed in any way, we should expect the development of venous and lymph stasis.
Some hemorrhoids are caused by varicose veins of the hemorrhoidal plexus. Likewise, prostatic hypertrophy may be due to varicose veins of the bladder, prostate, and rectum.
Other causes of prostatic venous stasis may be constipation and the consequent straining to move one's bowels, a prolonged upright position, lifting, habits which do not permit the frequent enough emptying of the bladder, and nervous tension (which produces bladder spasm, rectal spasm, and the retention of gas in the rectum). All of these conditions interfere with the proper venous return from the prostate gland."
Source: How to Stay Out of the Hospital
Also see: Interventional Treatment Of Benign Prostatic Hyperplasia: Embolization Of The Testicular Vein
- Successful trial in Portugal being followed up in UK with results due this year
- If it is successful the technique could be rolled out for routine use on the NHS
- Researchers expect it to largely replace surgery as the standard treatment
PUBLISHED: 05:00 BST, 8 March 2017 | UPDATED: 08:19 BST, 8 March 2017
Tens of thousands of men could benefit from a breakthrough prostate treatment announced today.
The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation.
A successful trial in Portugal is being followed up in Britain, with results due back later this year. If successful it could be rolled out for routine use on the NHS.
Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it.
As well as being painful and invasive, the operation can cause loss of sexual function and even incontinence.
+3
The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation
Last night, researchers said they expected the new technique – prostate artery embolisation – to largely replace surgery as the standard treatment.
An enlarged prostate presses on the bladder, while also blocking the urethra. This means sufferers need to make repeated night-time trips to the toilet, often to find they cannot urinate at all.
This can lead to a build-up of toxins that cause severe kidney problems. The bead technique has been tested on 1,000 middle-aged men in Portugal.
Joao Martins Pisco, who led the study at St Louis Hospital in Lisbon, said: 'Within five years I think this will replace surgery as the standard treatment.
'Prostate artery embolisation gives men a treatment option that is less invasive than other therapies and allows them to return to their normal lives sooner.
Time and time again, I see patients who are relieved to find out about prostate artery embolisation because they are not able to tolerate medications due to their side effects.
'These men also don't want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to prostate artery embolisation, which is generally performed under local anaesthesia and on an outpatient basis.'
The Portuguese team, which will present its findings at the Society of Interventional Radiology in Washington DC today, concluded the procedure is as effective as surgery and the benefits may last as long.
Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it
Only two patients in the seven-year trial had clinical side effects.
Performed under local anaesthetic, the procedure involves injecting hundreds of 0.2mm plastic beads into an artery in the groin.
The beads are directed with a thin tube into the blood vessels that flow to the prostate, blocking blood supply to the enlarged gland so that it shrinks.
Dr Pisco added: 'I have had nine babies born to men who were able to continue their sex lives after having the treatment.'
His team saw a 89 per cent success rate six months after surgery, 82 per cent success up to three years, and 78 per cent beyond three years.
Two hundred patients in Southampton General, Guy's Hospital in London and 16 other clinics are involved in the British trial, which is part-funded by the clinical watchdog NICE.
Dr Nigel Hacking, who is leading the study, said: 'It is very encouraging. I am always cautious about new techniques but this procedure seems to be showing promise and it seems to be safe.'
Louise de Winter of the Urology Foundation said: 'This research is very exciting.
'As the population ages these problems are going to get even more acute.'
An estimated 45,000 men undergo surgery for enlarged prostates every year in the UK.
Dr Pisco claims most of these could be replaced by prostate artery embolisation – although others say the less invasive procedure is not be suitable for all men, and many will have to continue to have surgery.
Two hundred patients in Southampton General (pictured) Guy's Hospital in London and 16 other clinics are involved in the British trial
Dr Hacking said that in his own experience, roughly 40 per cent of patients who have embolisation later have to undergo operations.
But having initial embolisation may enable them to delay that operation while retaining sexual function, and this usually means that when they do come to have an operation it is less invasive and there is a lower risk of side effects.
'Even if they do need to go back and have surgery it's a smaller operation,' he said.
Dr Hacking said it was unlikely the procedure will completely replace surgery, because it requires a highly trained interventional radiologist.
'It is a fiddly procedure and it would be potentially dangerous for someone without the skills to do it,' he said.
'But I think it may give men another option alongside surgery.'
Surgery, conducted either with a hot wire or lasers, have a high success rate - but they come with side effects which can include loss of sexual function, bleeding and incontinence.
The symptoms of enlarged prostate include a frequent need to urinate, but also difficulty starting to urinate and difficulty fully emptying a bladder.
These symptoms, however, also might be a sign of prostate cancer, so anyone in this way should be seen by a urologist.
British NHS has greenlighted the Prostatic Artery Embolization treatment:
Breakthrough prostate treatment rolled out on the NHS | Daily Mail Online (2018)
Pioneering prostate treatment for tens of thousands of men gets NHS green light (2018)
The studies:
https://www.researchgate.net/public...zation_for_Prostate_Cancer-Initial_Experience
https://www.researchgate.net/publication/321339938_Surgical_Treatment_Prostate_Artery_Embolization
https://www.researchgate.net/public...Embolization_for_Benign_Prostatic_Hyperplasia
https://www.researchgate.net/public...Prostatic_Hyperplasia_Results_in_630_Patients
See here for the studies: https://www.researchgate.net/scientific-contributions/46532827_Joao_Martins_Pisco
More sources:
Nonsurgical treatment for enlarged prostate remains effective for years
We have successful treatment using selective occlusion of veins on the one side:
Reversal Of Benign Prostate Hyperplasia By Selective Occlusion Of Impaired Venous Drainage In Males
And successful treatment using embolization of arteries on the other side:
Surgical Treatment: Prostate Artery Embolization (in a 1,000 patients trial)
Something tells me that the prostatic venous plexus and the prostatic venous drainage system have something to do with this...
From other topic What Would You Suggest For BPH Prostate Trouble?:
Prostatic venous plexus - Wikipedia
Even if there is no varicocele present, theoretically there could still be abnormalities of the prostatic venous plexus which cause proliferative problems with the prostate.
(retrograde flow of hormone-rich blood, etc.)
Finally I've found a good anatomical picture which shows all the relevant veins in a clear matter.
Source: Neurologic Complications of Prostate Cancer
Hormones cause varicose veins. Varicose veins cause back flow, bypassing of the blood, stagnant blood, leakiness of the veins etcetera. Where are hormones most frequently present? The pelvic area. So it wouldn't be such a strange idea that varicose veins cause BPH. Varicose veins that can't be seen, too. Like those of the prostatic venous plexus.
"3. The arteriosclerotic and varicose vein theory. With arteriosclerosis, or hardening of the arteries, there is a decrease in the caliber or gauge of the blood vessels to the prostate gland, which, receiving a deficient supply of blood, is thus not properly nourished. If varicose veins are present, venous stasis may be combined with deficient nourishment to bring on enlargement of the prostate.
Varicose veins of the urinary bladder are often noted in association with prostatic hypertrophy. These veins drain blood from the vesicoprostatic venous plexus. Bleeding from the prostatic capsule following prostatectomy is most often from enlarged veins. In the area of the prostatic capsule, a tight cover with a sphincter at each end, lymph and venous blood have difficulty circulating even under normal conditions. If the physiology is disturbed in any way, we should expect the development of venous and lymph stasis.
Some hemorrhoids are caused by varicose veins of the hemorrhoidal plexus. Likewise, prostatic hypertrophy may be due to varicose veins of the bladder, prostate, and rectum.
Other causes of prostatic venous stasis may be constipation and the consequent straining to move one's bowels, a prolonged upright position, lifting, habits which do not permit the frequent enough emptying of the bladder, and nervous tension (which produces bladder spasm, rectal spasm, and the retention of gas in the rectum). All of these conditions interfere with the proper venous return from the prostate gland."
Source: How to Stay Out of the Hospital
Also see: Interventional Treatment Of Benign Prostatic Hyperplasia: Embolization Of The Testicular Vein
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