Pros and cons of PAE surgery

DEAR DR. ROACH >>

I am 77 and have been suffering from an enlarged prostate for 20 years, waking up six times each night to use the toilet. Because my prostate is “extremely large,” according to my urologist, he suggested that I see my vascular surgeon (who previously cleared my leg artery blockage) for a prostate artery embolization (PAE). This involves small beads injected by the surgeon into the arteries that supply blood to the prostate, causing a reduction in blood flow and shrinking the prostate so that less compression on the urethra reduces the number of times I wake up.

Am I too old for such a procedure? Are the outcomes usually successful? Is such a surgery risky? What else do I need to consider?

— B.M.S.

DEAR B.M.S. >> PAE is an option for treatment in men with symptoms of an enlarged prostate that have not responded well to medical therapy. The American Urological Association describes this procedure as an option, but notes that they were “unable to find substantial evidence to recommend PAE over more widely available, minimally invasive therapies for the routine treatment” of a symptomatic enlarged prostate.

They also noted that “PAE is a technically demanding procedure” with “procedure times up to 2 hours,” but found that adverse events were reported half as much as in men undergoing traditional surgery. One unique side effect to PAE is called post-PAE syndrome, consisting of burning sensations in the area, along with nausea and vomiting.

Most trials have found that 80% to 90% of men have success. Compared to surgery, the risks are much less. (This is important for you, since you have had blockages in the artery of your leg, putting you at a higher risk for any kind of surgery.) Age alone is not a major consideration. Most men with enlarged prostates who undergo procedures are in their 60s and 70s. Even

80s is not unusual.

As the AUA mentioned, there are other minimally invasive procedures available, including heatbased, cold-based and laser treatment of the prostate. Your urologist has far more experience than I do regarding the risks and effectiveness of the different available options for a man with a very large prostate such as yourself. Still, I would ask your urologist for their opinion about other minimally invasive procedures for you.

DEAR DR. ROACH >> I got the updated COVID vaccine today. The pharmacist squirted out roughly a 6-inch to 7-inch stream from the syringe before he injected me. Do you think I got enough of the vaccine to be protected? He said I did, but I don’t feel confident. I am immunocompromised due to my meds for rheumatoid arthritis.

— L.S.

DEAR L.S. >> The updated COVID-19 vaccine may be dispensed to the pharmacy in either vials or prefilled syringes and can sometimes include slightly more than the 0.5-cc dose. So the nurse or pharmacist who gives you the vaccine may squirt out the extra dosage. We also often squirt out a little to be sure there are no air bubbles in the syringe. It can be surprising to many that a miniscule amount can make quite a long stream with such a tiny needle.

I understand why you are concerned. It’s particularly important for a person on medication that affects the immune system to be protected, but I think it very likely you got the full dose or a dose near enough that won’t affect the efficacy of the vaccine.