Doctors in Southampton are leading a nationwide study into the effectiveness of a new non-surgical procedure to treat men suffering from an enlarged prostate.
The technique, known as prostate artery embolisation (PAE), involves using a tiny plastic catheter inserted in the groin to place grain-sized particles into the arteries to cut the blood supply and shrink the gland.
Dr Nigel Hacking, a consultant interventional radiologist at Southampton General Hospital who performed the first two procedures in 2012 with colleague Dr Tim Bryant, is now training clinicians at a further 14 sites.
Enlarged prostate, which is also referred to as benign prostatic hyperplasia (BPH), forces the gland to expand onto the urethra – the tube between the bladder and penis – and delays the start of urination, increases the need to urinate and prevents patients’ emptying the bladder.
The condition affects around 60% of men over 60 and is usually treated with medication and lifestyle changes or, if these are unsuccessful, invasive surgery, which carries the possibility of side effects including incontinence and erectile dysfunction.
The National Institute for Health and Care Excellence (NICE) has now funded Cedar, an NHS academic evaluation centre at Cardiff University, to compare results of PAE with conventional surgery via a registry of prostate embolisation known as UK-ROPE.
A total of 17 centres in the UK will recruit more than 120 PAE patients over the period of a year and will close the study when all men have completed their 12-month follow-up. The results will be reported to NICE by the end of 2016.
“Our interim results have shown excellent symptomatic improvement and our conclusion locally is that PAE appears safe and effective in around 80% of men,” explained Dr Hacking, whose team has now performed 70 procedures in Southampton.
“There is a small incidence of recurrence and it may well be that in a group of patients a repeat or alternative procedure will be required after a few years.”
But Dr Hacking, who is chairman and clinical adviser for the UK-ROPE standing committee, said the benefits of the procedure appeared to outweigh any disadvantages.
“PAE is a day case procedure which takes one to two hours under local anaesthetic with the patient home within four to six hours with little or no recovery period required,” he said.
“This compares to a two to three day hospital stay and a month-long recovery and rest period following surgery.
“Most importantly, particularly for men in their 50s and 60s, sexual function is maintained and there is no risk of incontinence, so our urological surgeons here feel there may be nothing to lose in trying the technique first.”
Dr Hacking, who helped developed a similar method to shrink fibroids in women known as uterine fibroid embolisation (UFE), added: “If successful then we will radically improve treatment options but, if not, nothing has been lost.
“In fact, traditional surgery may be made easier and safer as prior embolisation should reduce blood loss during surgery.”
Posted on Thursday 22 January 2015