Foam injections that ease prostate trouble
MILLIONS of tiny foam particles injected into a blood vessel could help tackle a common prostate condition, benign prostatic hyperplasia (BPH). This affects 2.5 million men in Britain and occurs as a result of ageing, causing the prostate gland to become enlarged. This can lead to kidney problems if left untreated. In the new treatment, man-made particles, little bigger than a grain of sand, are used to block the artery that supplies the prostate with blood. As blood flow is reduced, the gland begins to shrink.
The prostate is a doughnut- shaped gland that surrounds the urethra, the exit tube from the bladder. Roughly the size of a walnut, it is responsible for producing semen and tends to grow as a man ages.
This is possibly due to the hormone testosterone, which appears to stimulate the growth of prostate cells.
The first sign of an enlarged prostate is usually trouble passing urine or difficulty starting even when the bladder is full.
As the condition progresses, the man may need to get up several times a night and many sufferers also experience incontinence during the day.
Untreated, BPH can cause kidney damage if it becomes impossible to urinate. It can also lead to bladder stones, depression and daytime tiredness due to broken sleep.
Most men are treated with drugs that they take for the rest of their lives. Treatment often involves alpha- blockers, which relax muscle fibres within the prostate, so that the gland exerts less pressure on the urethra. But the side- effects include dizziness and headaches.
Another group of drugs are 5alpha-reductase inhibitors, which cause the gland to shrink. However, up to one in 20 men taking them develop erection problems.
If medication does not work, another option is surgery — around 50,000 men a year end up having an operation to remove the excess prostate tissue. But surgery is not always successful and can cause pain and bleeding.
The new treatment, known as prostatic arterial embolisation, is a minimally invasive procedure.
First, the doctor makes a tiny incision in the femoral artery, the major blood vessel in the thigh, and inserts a thin tube called a catheter.
Using X-ray imaging and local anaesthetic, the doctor guides the tube through the body’s network of blood vessels until it reaches the prostatic artery, the major source of blood for the gland.
At the press of a button, millions of tiny foam particles are released through the tube and into the artery. These are made from a harmless synthetic material, called polyvinyl alcohol, which is already widely used in other areas of medicine (for example, in drops to treat dry eyes — the particles bond together to form a lubricating film over the eyeball).
Though the foam particles are hard, once they come into contact with blood and fluids deep inside the artery they soften and clump together to
reduce the blood supply to the prostate. Deprived of nutrients, the enlarged prostate begins to shrink over a matter of weeks or months, easing pressure on the bladder and relieving symptoms.
Because there is still a small amount of blood getting through to the gland, it does not die off completely, but simply reduces in size.
Most men are able to leave hospital within four hours of the treatment and experience little or no pain afterwards.
In a recent study, published in the Journal of Vascular Interventional Radiology, researchers used the new therapy to treat 15 men with an enlarged prostate.
After seven months, prostate volume had shrunk in 14 of the men, with few bladder problems and better erectile function — the men also reported better quality of life.
PROFESSOR Roger Kirby, a trustee of the charity Prostate Action, said the new technique ‘ has potential’ to improve treatment of enlarged prostate.
‘Cutting off that blood supply is one way of reducing the growth. But it’s early days and we need longer-term data to see how long the treatment lasts,’ he says.
Meanwhile, research suggests a drug used to treat benign prostate enlargement could be used to tackle early stage prostate cancer.
In a three-year study, half of a group of 302 men with low-risk, early-stage prostate cancer were given a daily tablet of 0.5mg dutasteride, used for benign prostatic hyperplasia, while the other half were given a placebo.
Overall, findings showed that treatment with dutasteride significantly delayed prostate cancer progression compared with the placebo — 38 per cent of the men receiving dutasteride experienced disease progression compared with 48 per cent given the placebo.
Additionally, men treated with dutasteride were less likely to have cancer detected in their final biopsy. However, experts caution that this treatment does not work against advanced cases of the disease.