Prostate artery embolization, a technique pioneered at the University of Miami Miller School of Medicine, continues to offer men with benign prostatic hyperplasia (BPH) or prostate enlargement a more convenient, less invasive alternative to surgery.
UM interventional radiologists remain on the forefront of this innovation in both advancing treatment and research. Having the most extensive expertise on prostate artery embolization (PAE), UM interventional radiologists have performed more than 800 minimally invasive, outpatient PAEs – more than any other institution in the United States.
“We have not only been leaders in terms of clinical care delivery, but also in terms of research and education,” said Shivank Bhatia, M.D., chair of the Department of Interventional Radiology at the Miller School of Medicine. “I personally taught more than 300 physicians how to perform this technically challenging procedure.”
The technique involves guiding a catheter through a small incision in the upper thigh or through the wrist (a transradial approach). Using X-ray guidance, the physician then injects tiny beads into the arteries leading to the prostate. The intervention shrinks the size of an enlarged prostate by about 30-40% over three months due to reduced blood supply.
Typically, about half of men older than 50 experience BPH. Generally, medication is the first-line therapy. When medications do not work, surgery is often the next option. Dr. Bhatia pioneered the PAE technique to give certain men with larger prostates, who may have other illnesses and may not tolerate or be willing to undergo surgery, another option to consider.
“Many of these patients could benefit from a minimally invasive, outpatient, image-guided procedure, with same day discharge and rapid recovery, but more importantly, with no long-term side effects on sexual and urinary function,” Dr. Bhatia said. Recovery at home typically takes five to seven days and most men can stop taking their BPH medication four weeks after the procedure.
As UM continues to advance PAE, it also leads the nation in a transradial approach for this technically challenging procedure. This approach provides patients with quicker recovery and a better safety profile. Patients favor radial access because it allows immediate ambulation, faster recovery and features lower risks overall compared to the femoral approach, said Dr. Bhatia.
For some individuals, PAE is associated with significantly less bleeding and a better quality of life compared with a surgical procedure called transurethral resection of the prostate (TURP), Dr. Bhatia reported in 2019 in Radiology Today. Since that publication, the number of men who have opted for PAE at UHealth—the University of Miami Health System has increased from more than 550 to over 800. In addition, Dr. Bhatia has updated the technique and now injects beads of different sizes – customized based on the size of the prostate gland.
The FDA approved the PAE procedure in June 2018. The patient who shares his experience before and after the technique in this video is typical of about 90 percent of the patients he treats, Dr. Bhatia said.
As more and more physicians treating men with BPH learn about the advantages that PAE can offer, particularly for patients with larger prostate glands who may not want or be able to tolerate surgery, Dr. Bhatia believes more men will be referred to UM and elsewhere to undergo the procedure. “PAE should become more and more of a front-line option for many of these patients before surgical intervention is offered to the patient. However, at UM, experts in the Department of Urology offer the entire spectrum of treatments such as Holmium Laser Enucleation of Prostate (HoLEP), TURP and Rezum for men with BPH.
“As a result, we believe that we have a very unique opportunity to personalize the management of BPH and tailor it to the individual patient better than anywhere else,” said Dr. Bhatia.
“Men with hematuria can also be good candidates for PAE,” said Mohamed Kably, M.D., associate professor of radiology at UHealth. Hematuria presents as blood in the urine and can be caused by BPH or prostate cancer. Hematuria can be a chronic condition or an acute, life-threatening hemorrhagic event, said Dr. Kably, whose research focuses on the therapeutic potential of PAE in this patient population.
Similar to BPH, therapy is generally prescribed in a step-wise fashion, starting with conservative measures, followed by medication, blood transfusions and invasive surgery, as needed. Research at UM demonstrates that PAE can stop prostatic bleeding and reduce lower urinary tract symptoms in many men, thereby obviating the need for future treatment.
Bruce Kava, M.D., director of men's health at UM, said, “The University of Miami's Interventional Radiology group is one of the few places in the country where some of the most challenging patients with bothersome urinary symptoms can turn for minimally invasive treatment using prostate artery embolization.
“Dr. Bhatia and his team are internationally recognized for their excellent outcomes and few complications,” Dr. Kava added. “We are truly fortunate to have their expertise here in South Florida."
“With a multidisciplinary team comprised of urologists and interventional radiologists, we believe that we have a very unique opportunity to personalize the management of BPH and tailor it to the individual patient better than anywhere else,” said Dr. Bhatia.