Improving Quality of Life with PAE

Waking up throughout the night to urinate is often the first indication any man gets that all is not right with his prostate. A relatively new radiology treatment, introduced at the Society of Interventional Radiology's 2016 Annual Scientific Meeting, addresses this problem and may be able to improve the quality of life for thousands of men with enlarged prostates.

The procedure is known as a prostatic artery embolization (PAE). In the procedure, a catheter is inserted into the femoral artery and guided to the prostate artery on both sides of the enlarged prostate gland. Once it is in position next next to the prostate, the catheter is used to deliver microscopic spheres to block blood flow. This in turn causes the prostate to shrink.

"Waking in the night with an urgent need to urinate, or nocturia, significantly disrupts the lives of men by preventing them from having a full night's sleep," said Sandeep Bagla, MD, the study's lead researcher and an interventional radiologist at the Vascular Institute of Virginia. "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. For these individuals, PAE has the added benefit of being less invasive compared to other treatments and is performed on an outpatient basis, allowing many men to go home the same day."

The researchers conducted a retrospective analysis of 68 men who had benign prostatic hyperplasia– an enlarged prostate – and lower urinary tract symptoms who had underwent PAE at the Vascular Institute of Virginia and the University of North Carolina at Chapel Hill. The team examined patient-reported quality of life scores, ranging from 0 (delighted with their current status) to 6 (current condition is unbearable). The American Urological Association (AUA)  seven-question symptom index was also used as a metric, with scores ranging from 0 (not bothered by urinary symptoms) to 35 (very bothered by urinary symptoms). Bagla's analysis examined both scores before and after treatment, at the one month and three month point.

At one month, a follow-up with 46 of the original 68 patients was conducted. All 46 patients reported an average 10-point reduction in AUA scores and an average quality of life score improvement of 2.1; that is, their urinary symptoms bothered them less and their quality of life showed improvement.

At three months out, 28 of the 38 patients who followed up indicated a 13.4-point reduction in AUA scores and a 2.8-point improvement in their quality-of-life scores.

While this study clearly demonstrated that PAE resulted in the reduction of nocturia for men with lower urinary tract symptoms and BPH, the researchers noted that the treatment may not completely eliminate nocturia.