The tiny marbles that can shrink a swollen prostate
AN ENLARGED prostate is common in older men. A new procedure to treat it is being trialled in NHS hospitals. Nevil Bennington, 57, a courier from Banbury in Oxfordshire, underwent the treatment, as he tells OONA MASHTA.
THE PATIENT
AT THE beginning of last year I began to have episodes of needing to rush to the loo, but finding that nothing would happen when I got there.
In March, it reached crisis point. I needed the loo, but for an entire night I just couldn’t go and it became very painful.
At 4am, I drove to A&E, where they fitted me with a catheter (a tube) to drain my bladder — it was such a relief.
I had to wear a catheter for the next month before I saw a urologist. Tests revealed I had an enlarged prostate, which was pressing on my urethra, blocking the flow of urine from my bladder.
At first, I was prescribed a drug that would shrink the prostate. Thankfully, i t worked, so the catheter was removed.
But I didn’t want to be on drugs for the rest of my life, and was worried they might cause sideeffects, so I asked my urologist for any alternatives.
I was told about a very invasive operation called trans urethral resection of the prostate (TURP), where they cut out most of the prostate gland. But it can leave you incontinent or impotent, and I didn’t want to take the risk.
So, when the consultant told me about an experimental, less invasive procedure called prostate artery embolisation, which was being trialled at another hospital in the trust, I was keen to try it. This would involve using tiny plastic particles to partially block the blood supply to the prostate to shrink it. It would effectively kill the prostate, but if this didn’t work, I could have the gland removed.
In november, I had a biopsy to make sure the enlarged prostate wasn’t cancerous. I wasn’t too worried about it, but, of course, was relieved it wasn’t cancer. In December, I went into the Churchill Hospital in Oxford where, under local anaesthetic, the doctor made a tiny cut in my groin. I couldn’t feel anything apart from a slightly warm sensation that I had been warned about: this was when they inserted the dye into the arteries to make them visible under X-ray so they could guide the particles to the right place.
I went home that day, in no pain, and was back at work the next day. Two weeks after the procedure I came off the prostate tablets.
Three months later, a scan revealed my prostate had shrunk by a third. I hope it continues shrinking until it’s a normal size. I have no symptoms, am going to the loo as normal and feel absolutely fine.
THE SPECIALIST
DR ChaRles Tapping is a consultant interventional radiologist at Oxford University hospitals nhs Trust. An EnLARGED prostate, also known as benign prostatic hyperplasia (BPH), is a common problem affecting 60 per cent of men over the age of 60.
The prostate is a doughnutshaped gland that lies under the bladder and surrounds the urethra, the tube through which urine passes.
It is usually the size of a walnut, but can grow to three times as big. This is thought to be linked to hormonal changes that occur as men age, such as the fall in testosterone and the relative increase in oestrogen.
About half of men with an enlarged prostate experience some symptoms: it can obstruct the flow of urine, leading to difficulty urinating or emptying the bladder fully.
There may be an increased need to urinate at night and a degree of incontinence. In severe cases, it can block flow completely, so patients will need a catheter.
Initially, doctors may recommend lifestyle changes, such as avoiding alcohol and caffeine, which can irritate the bladder, and not drinking after 8pm.
We can also prescribe drug treatments, which relax the muscle in the prostate and the bladder, making it easier to pass urine, or shrink the gland itself.
However, these drugs can potentially cause side- effects, for instance the drugs to stimulate the prostate may lead to impotence. If the prostate continues to grow, there is a surgical option, transurethral resection of the prostate (TURP), which involves cutting away part of the prostate with a hot wire or laser.
But this can cause nerve damage, resulting in impotence and urinary incontinence, and it can take up to three months to recover from the surgery.
now we have a new minimally invasive technique, prostate artery embolisation ( PAE), which is being trialled around the country.
Here, we insert a tiny plastic catheter (or tube) into the groin and, through this, we insert grain-sized plastic particles into some of the arteries to cut the blood supply, which shrinks the prostate.
It takes just one to two hours under local anaesthetic. There is no bleeding and little pain, and t he patient goes home i n about four hours with limited recovery time needed.
Most importantly, particularly for younger men, sexual function is maintained and t here i s no risk of incontinence, so there may be nothing to lose in trying this technique first — studies show that it is effective in 80 per cent of cases.
Ten per cent of men who have this new procedure have a recurrence of symptoms within three years — thought to be because blood will eventually get through the plastic particles — but as it’s only an outpatient procedure, this doesn’t tend to put patients off having it.
Under X- ray guidance, we start by injecting a dye through the groin so the arteries are visible.
Then, we cut a 1.5 mm hole in the main artery in the groin and feed a catheter through it up to the arteries that supply the prostate. Then we put another catheter, through the first one — this releases tiny plastic particles, which are about a tenth of a millimetre in diameter, so they gradually block each artery.
We use CT scanning to make sure they go to the right place.
Usually about two or three arteries are blocked, so the prostate will shrink.
It shrinks by about 30 per cent in a few weeks, so while it will still be slightly enlarged, it should be more manageable.
We withdraw the catheters and press on the hole for a few minutes to stop bleeding. The patient will be given antibiotics, painkillers and anti-inflammatories to prevent infections, pain and swelling after the procedure.
Within a few weeks, most men see a reduction in needing the loo at night, but real improvement comes at three months. THE plastic particles should become absorbed naturally, but it’s too new to say exactly what will happen.
This procedure could help many men, but until we know if it is as effective as we hoped, it’s too soon to offer it to all patients.
A trial has been launched to compare the results of this procedure with the conventional surgery, TURP. A total of 17 centres in Britain will recruit more than 120 PAE patients over a year. nevil was treated as part of the trial. Suitable candidates for the trial are men for whom medication didn’t work, who f ound t he si de - effects of drugs unacceptable or who have a large prostate with severe symptoms. It may not always be suitable for those over 80 because arteries can be too difficult to work with as you age. Results so far from Southampton General Hospital, which is leading the trial, have shown excellent i mprovement in symptoms.
The procedure appears safe and effective in about 80 per cent of men.
ANY DRAWBACKS?
DR NEIL BARBER, a consultant urologist surgeon at Spire Park Hospital and Frimley Park Hospital nHS Foundation Trust in Surrey, says: ‘This is a very interesting procedure, which may be suitable for some men.
‘But there will need to be high-quality trials comparing it with placebo and other goldstandard treatments such as TURP to ensure it is a good use of nHS money.’
The procedure costs the nhs about £3,000. To find out about taking part in the trial, patients should ask their gp for a referral to a urologist or for their urologist to refer them.