Men facing prostate surgery could avoid post-operative impotence with a simple new treatment called Prostatic Artery Embolization that uses microscopic plastic beads.
The procedure is set to revolutionize how men with an enlarged prostate or benign prostatic hyperplasia (BPH) are treated.
At the moment, the standard treatment is to cut out a section of the swollen prostate. But complications are common following this operation, and every year thousands are left suffering with sexual dysfunction, incontinence, infection and bleeding.
Prostatic Artery Embolization can be done under a local anaesthetic using a catheter (a small plastic tube) to inject tiny plastic particles no bigger than a grain of sand into the blood vessels that feed the swollen prostate.
Prostatic Artery Embolization can be done under a local anaesthetic using a catheter (a small plastic tube) to inject tiny plastic particles no bigger than a grain of sand into the blood vessels that feed the swollen prostate
Radiologists pinpoint where to deposit the tiny spheres by watching on an X-ray television monitor as they insert the catheter through the thigh’s right femoral artery and into the tiny blood vessels that branch off it.
These spheres “plug” these blood vessels, reducing the blood flow to the prostate and forcing it to shrink by as much as a third. The remaining blood supply allows the prostate to function at a healthier level.
“With a faster recovery, reduced symptoms, improved urination and fewer potential side effects, it could lead to changes in accepted prostate therapy,” say researchers.
Clinical trials in Portugal and Brazil have indicated that the procedure is effective and safe, with minimal side effects and no risk of incontinence or impotence.
Most of the 200 cases involved in the studies went home within four to six hours of treatment.
In particular, one trial, conducted at the University of São Paulo, Brazil, showed that there was an average 30% reduction in the size of the gland after treatment.
Another, based on 84 men who were followed for nine months after the operation, reported a 98.5% success rate, with 91.7% of patients saying they had extreme improvement in their symptoms.
Currently, half of all men will show tissue change associated with benign prostatic hyperplasia (BPH) by the age of 50 – a figure that increases to 75% among 80-year-olds.
Although not life-threatening, the condition sees the prostate – a walnut-sized gland surrounding the urethra, which carries urine out of the body – swell so big that it causes an obstruction. Symptoms include poor urine flow, more frequent urination, urinary tract infections and an inability to empty the bladder.
There are a number of surgical techniques, with Trans-Urethral Resection of the Prostate (TURP) considered the standard treatment.
In this procedure, carried out under general anaesthetic, sections of the prostate are shaved off to ease the blockage.
Conventional drug treatments include alpha-blockers, which work by relaxing the muscles at the neck of the bladder and in the prostate, and alpha-reductase inhibitors, which block production of a hormone called DHT, which contributes to prostate enlargement.
Some drug therapies are associated with side effects including dizziness and headaches.
But prostatic artery embolization could side-step such issues. And it has already been used in cases of advanced prostate cancer complicated by intractable bleeding.
The FDA has approved Cialis (tadalafil) on October 6 to treat the signs and symptoms of benign prostatic hyperplasia (BPH), and for the treatment of BPH and ED.
“BPH can have a big impact on a patient’s quality of life. A large number of older men have symptoms of BPH. Cialis offers these men another treatment option, particularly those who also have ED, which is also common in older men,” said Scott Monroe, director of the Division of Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research.
The FDA has approved eight other drugs to treat symptoms of BPH: Proscar, (finasteride), Avodart (dutasteride), Jalyn (dutasteride plus tamsulosin), and the alpha blockers: Hytrin (terazosin), Cardura (doxazosin), Flomax (tamsulosin), Uroxatral (alfuzosin) and Rapaflo (silodosin).
Benign prostatic hyperplasia (benign prostatic hypertrophy, benign enlargement of the prostate, adenofibromyomatous hyperplasia), is a condition in which the size of the prostate is increased. Around half of men over 50 suffer from prostate conditions, and difficulty urinating.
Cialis (tadalafil) was approved for BPH treatment.
Tadalafil is a phosphodiesterase type 5 inhibitor (PDE5 inhibitor), used for treating erectile dysfunction as Cialis, and as Adcirca for pulmonary arterial hypertension. PDE5 inhibitor relaxes the blood vessels supplying the corpus cavernosum.
Cialis was approved by FDA in 2003 the third ED prescription pill, after sildenafil citrate (Viagara) and vardenafil (Levitra). All of them are as needed medication. Cialis, the weekend pill, has 36-hour effectiveness and can be take as once-daily medication.
Common symptoms of BPH include difficulty in starting urination and a weak urine stream; a sudden urge to urinate; and more frequent urination including at night.
The severity of symptoms of BPH can be measured using the International Prostate Symptom Score (IPSS).
In two clinical trials, men with BPH who took 5 mg of Cialis once daily experienced a statistically significant improvement in their symptoms of BPH compared to men who were treated with placebo.
The trials based their findings on a reduction in total IPSS scores.
In a third study, men who experienced both ED and BPH took 5 mg of Cialis once daily and had improvement in both their symptoms compared to men who were treated with placebo.
Cialis should not be used in patients taking nitrates (nitroglycerin, isosorbide dinitrate), often prescribed for chest pain (ischemic heart disease), or if a person takes recreational drugs, poppers (amyl nitrite, butyl nitrite). The combination can cause an unsafe decrease in blood pressure.
The use of Cialis in combination with alpha blockers for the treatment of BPH is not recommended because the combination has not been adequately studied for the treatment of BPH, and there is a risk of lowering blood pressure.
Cialis is manufactured by Indianapolis-based Eli Lilly and Co. The longer-lasting Cialis could overtake Pfizer’s drug and become the market leader for ED drugs, said John Lechleiter, Eli Lilly CEO, in July 2011.