This blog will vary from our usual question and answer format. I would like to share my recent experience with treatment for benign enlargement of my prostate at UCLA. The prostate gland wraps around the urethra (the tube carrying urine from the bladder to the penis). In more than 90% of men, this gland grows as we age, and in doing so, can create a number of symptoms including:
- Feeling that the bladder is full, even right after urinating
- Frequency, having to urinate small amounts very frequently
- Urgency, feeling that urinating "can't wait"
- A weak flow of urine
- Needing to stop and start urinating several times
- Trouble initiating urination
- Needing to push or strain to urinate
- Incontinence, the possibility of urine leaking from the penis when not urinating
As the prostate enlarges, it presses against the urethra, decreasing the diameter, making it harder for urine to get out, and the bladder wall becomes thicker. The bladder may weaken and lose the ability to empty fully, leaving some urine in the bladder. Narrowing of the urethra and urinary retention – being unable to empty the bladder fully – cause many of the problems of benign prostatic hypertrophy (BPH). This is a benign condition, does not lead to cancer but cancer may be found in someone with cancer. Men over 50 should see a urologist yearly for a rectal exam (and biopsy if necessary) to rule out prostate cancer.
Mild symptoms can be treated with one of three classes of drugs. These are: Alpha blockers, which relax the muscles of the prostate and neck of the bladder to relieve symptoms. Examples of alpha blocker medications include: alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and terazosin (Hytrin). I have been taking tamsulosin for years but my symptoms were getting progressively worse to the point where I had to get up every two hours to urinate, making it impossible to get a good night’s sleep. Last night, for the first time in years, I was able to sleep all night without having to get up. And I’m done taking tamsulosin!
What are the treatment options when the medications no longer work? Minimally invasive surgery can be done with minimal anesthesia, as on outpatient. The procedure may be done in a doctor's office or at an outpatient surgery center.
Choosing the right type of minimally invasive surgery for you may depend on:
- The size of your prostate
- How healthy you are
- Your personal choice
According to the Urology Care Foundation website, the following are procedures to choose from, including:
- Prostatic Urethral Lift (PUL)
- Convective Water Vapor (steam) Ablation (Rezum)
- Transurethral Microwave Thermotherapy (TUMT)
- Transurethral Water Vapor Thermal Therapy
The time honored treatment for BPH involves sticking an instrument (cutting, lasering, ultrasound, etc.to break up the prostate) in a treatment called a transurethral resection of the prostate (TURP). These treatments work for sure but can leave the patient with bleeding through the penis, the need for a catheter, and for me, worst of all, a very definite possibility of losing the ability to have an erection (I enjoy that too much to lose at my age and was not willing to take that chance)!
And in big bold letters, the Foundation’s web site states that the treatment I had, prostatic artery embolization (PAE), is NOT recommended. I was also told the same thing by the two excellent urologists I met with before deciding to have my prostatic arteries embolized. Why are urologists so against the PAE procedure? The answer is relatively simple – a urologist’s bread and butter, where most of their income comes from, is from treating BPH. PAE is performed by interventional radiologists (IR, a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions with tiny cannulas)! PAE symptoms related to Benigostatic Hyperplasia
I found out about this procedure from a patient of mine, who travelled to Virginia to have the procedure performed, about five years ago. Now the procedure is becoming more popular and most major centers have someone trained to do the procedures. Dr. Justin McWilliams (Associate Professor, Interventional Radiology Director, Fellowship program Co-Director, UCLA HHT Center of Excellence, David Geffen School of Medicine at UCLA, 757 Westwood Ave., Suite 2125C, Los Angeles, CA 90095, Phone: (310) 267-8773) was recommended to me by an interventional radiologist I know well from our medical building, Dr. Neil Goldstein, who does awesome work here unplugging arteries, etc., but he does not do PAE. I could not have been more pleased with the referral. Dr. McWilliams is technically excellent and a super nice human being. I would highly recommend saving his contact information for the next time you hear someone talking about treatment for BPH! I had excellent care from all who I met at UCLA!
So what is prostatic artery embolization? Mine was done at the Ronald Regan Medical Center at UCLA and the procedure took three hours with me being wide awake. During this procedure, a tiny catheter is passed into your femoral artery in the groin and under radiological control (three D CAT scans with contrast material), the prostatic arteries are mapped out and the branches going just to the prostate are embolized (tiny beads are released which plug up the vessels going to the prostate, causing that part of the prostate to die and shrivel up). That part did not hurt at all but whenever they injected some contrast material (dye) into a branch that went to the rectum or penis, I felt a brief hot flash. The hole in the femoral artery is patched with a collagen plug and I had to sit around the recovery room for 3 hours after the procedure so the staff could make sure I was not bleeding from the groin. Dr. McWilliams told me it could take up to a month to see the improvement but I was able to urinate easily, without straining, while in the recovery room at UCLA. Since leaving, I have slept through the night, urine flows as well as it did when I was 30 years of age. I worked out in our home gym before going back to work the very next day (procedure was Thursday, I returned to work on Friday). I avoided blood and catheters in my penis. And, oh yes, “it” works!
Just to be clear, this treatment is for BPH and not for prostate cancer! I have a prediction to make – there are going to be a lot less urologists and many more interventional radiologists doing prostates in the future.