The prostate treatment that avoids surgery

Read time: 1.5 minutes

There comes a point in many men's lives where they become fed up with the symptoms of a benignly enlarged prostate. These include getting up to the bathroom several times during the night, passing urine and then a few minutes later having to go back again (what urologists call an 'encore'), poor stream force, and sometimes infection from having urine left in the bladder.

There are medications which can help but vary in effectiveness and probably don't prevent the eventual need for surgery. There are many surgical techniques for reducing the size of the prostate, from cutting it out from the inside, laser reduction, and even steam. Recovery from these procedures can take a while, with the discomfort of a catheter for a few days.

Embolisation reduces the size of the prostate more, has fewer side effects including erectile dysfunction, and improves men's symptoms to a much greater extent than medication

But there is a non-surgical treatment which can be done as a day case without significant anaesthesia, rarely the need for a catheter afterwards, and fewer potential complications.

It's called prostate artery embolisation, carried out by a specially trained radiologist who guides a catheter through the arterial system from the wrist or thigh to the artery supplying blood to the prostate gland. They then inject tiny beads which block part of the blood supply, and as a result, over a period of days and weeks, the prostate shrinks.

Radiologists in Queensland have been pioneers of the technique and conducted clinical trials, particularly comparing it to medication. The most recent, the P-EASY ADVANCE study from the University of Queensland and I-MED Radiology, compared embolisation directly against combination medical therapy in men who had never been treated before. Across every measure tested, including prostate volume, urinary obstruction, symptom scores and quality of life, embolisation outperformed medication.

Embolisation reduces the size of the prostate more, has fewer side effects including erectile dysfunction, and improves men's symptoms to a much greater extent than medication.

It is reimbursable, and an increasing number of radiologists have been and are being trained in embolisation. The main barrier at the moment is that the clinical guideline on treating prostatic hypertrophy is controlled by urologists, some of whom are still hostile to the idea of this non-surgical approach.

For men fed up with medication and wary of surgery, it's a referral pathway worth knowing about.