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Study Finds that Prostate Treatment Preserves Fertility

Study of PAE determines no impact on fertility with treatment

May 3, 2019
Lani Redinger

Fertility is a two way street and can be impacted from the male or female. Often times the focus is placed more frequently on female fertility, but statistically fertility is impacted 35% by male factors, 35% of the time by female factors, while 20% of infertility cases are impacted by both and in 10% the cause is unknown. That means men’s reproduction health and overall health can equally impact a couples fertility.

Prostate Artery Embolization (PAE)

PAE is a nonsurgical option to shrink the prostate

The study was conducted by Martins Pisco, M.D., Ph.D., director of radiology at Saint Louis Hospital, Lisbon, Portugal. It suggests that PAE is a successful intervention for men with prostate issues without surgery. PAE is a relatively new, minimally invasive, image-guided treatment performed by interventional radiologists. The PAE procedure is a good fit for patients who are either ineligible or not interested in traditional surgery.

With PAE, an interventional radiologist makes a tiny incision in the groin and advances a small tube, called a catheter, to the prostate artery. Microscopic beads are released into the artery, where they lodge and temporarily block blood flow to the prostate, causing it to shrink. PAE currently is the focus of several U.S. trials.

The treatment can help resolve urinary tract symptoms associated with Benign Prostatic Hyperplasia (BPH). BPH is a noncancerous enlargement of the prostate gland and is the most common benign tumor found in men. Men with BPH can experience annoying symptoms such as frequent trips to the restroom, retrograde ejaculation, and erectile dysfunction, the latter of which can impact fertility.

As men age, the prostate gland slowly enlarges and may press on the urethra and cause the flow of urine to be slower and less forceful. Enlarged prostates cause urinary frequency, urgency, passing urine more often (particularly at night), weakened stream and incomplete bladder emptying. These symptoms can have a significant impact on a man’s quality of life, leading many of those experience it to seek some form of treatment.

The standard treatment for BPH, is surgery, which requires general anesthesia and can cause complications, such as sexual dysfunction, impotence, urinary incontinence, and retrograde ejaculation, when semen enters into the bladder. Alternatively PAE, can be performed under local anesthesia and involves temporarily blocking blood flow to the arteries that supply the prostate, a treatment called embolization.

Diagram of enlarged prostate compared to normal prostate
An enlarged prostate can have a significant impact on quality of life for men

Study Metrics and Results

The results of the study proved promising for men with enlarged prostates

The study looked at  nearly 500 men dealing with issues associated with an enlarged prostate. Of the participants 72% experienced symptom improvement three years after having PAE performed. This is the largest study of its kind. In fact, 148 (31.6 percent) of our treated patients reported improved sexual function. It was observed that the larger the prostate and the more severe the symptoms are, the better the results of PAE.

The study revealed that shrinking the prostate with PAE is similar to surgery with less complications. Martins Pisco, M.D., the lead study authors noted, “Patients are discharged three to six hours after the treatment with most of the individuals we've treated noting almost immediate symptom relief. I believe PAE could eventually become standard treatment for enlarged prostate." He goes on to note, "Our study confirmed that PAE does not cause sexual dysfunction and preserves fertility."

Success rates in 469 patients (ages 45−89) treated with PAE were as follows:

  • 87.2 percent at three months,
  • 80.2 percent at 18 months
  • 72.3 percent at three years

One patient suffered from lack of blood flow to the bladder wall that was corrected by surgery, and one patient had pain that lasted three months. In cases where the problem recurred, it often could be re-treated with PAE.

"These results are very promising for American men," said SIR President-elect James B. Spies, M.D., MPH, FSIR.  Spies noted that this treatment is an advanced embolization procedure requiring rigorous training and a detailed knowledge of the prostate anatomy and surrounding vessels. "Interventional radiologists are leaders in bringing forth new treatments such as these responsibly," said Spies. He also noted that additional study is needed to further establish the safety, efficacy and durability of this treatment before it will become broadly available in clinical practice.

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