Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. We're here to talk about a common problem men have as they age. They need to urinate frequently, but then often feel like they can't go or have a weak stream or feel like they can't even empty their bladder. It could be caused by an enlarged prostate, and there is a non-surgical treatment for it called prostatic artery embolization.

Joining me is Dr. Jack Burt. He's an interventional radiologist at Nebraska Vascular and Interventional. Dr. Burt, thank you so much for joining us today. I'd like to start by having you explain a little bit about the prostate itself. What happens to the prostate as men age?

Dr. Jack Burt: Yeah. Thanks so much for having me, Melanie. Really looking forward to discussing this topic. So, I guess kind of the first question is what is the prostate? The prostate is a gland that's part of the male reproductive system, and it sits just beneath the bladder, and wraps around the urethra, which is the tube that carries urine out of the body from the bladder. So, that's the prostate.

An enlarged prostate is an extremely common condition in aging men. it's called benign prostatic hyperplasia or BPH. In younger men, the prostate is normally the size of like a walnut, as men age, the prostate often continues to grow in size. As men reach their 40s and 50s, the prostate is usually about the size of a golf ball, and it can stay that same size throughout the rest of their life, or it can actually continue to grow and grow and sometimes get to the size of a baseball or a softball when they get to their 60s and beyond.

So, the problem with that is because the urethra runs through the prostate, that growth of the prostate can slowly squeeze that urethra. It's almost like stepping on a garden hose. What is important for patients to understand, though, BPH is not prostate cancer. Now, prostate cancer can increase the size of your prostate. But BPH, it's a benign non-cancerous enlargement of the prostate. it can still significantly impact quality of life, though.

Melanie Cole, MS: Well, that was a great explanation, Dr. Burt. You explained it all so well. So when the enlarged prostate presses on that urethra, it can affect bladder function and quality of life. And so, we're going to talk a little bit about those symptoms, those quality of life symptoms. So, tell us those symptoms. What happens as the prostate enlarges? What are men experiencing?

Dr. Jack Burt: So, the most common symptoms of an enlarged prostate, it's urinary symptoms that slowly worsen over time. It typically starts in the 40s or 50s and just continues to get worse over time as males age. So most men with BPH, they'll describe waking up multiple times at night to urinate like three or more times, and that it's significantly impacting their sleep.

They have to drink like six cups of coffee in the morning to not feel like a walking zombie throughout the day. Most men with BPH have a weak stream. They have difficulty getting started. They have to push to start and then frequently start and stop while they're urinating. Oftentimes they have sudden urges to urinate all of a sudden. And then, even after they get done, they feel like they really never completely empty their bladder. So, like I said, a lot of guys just think that this is kind of part of getting older and it can be a sensitive topic. They'll say something like, "Well, I figured it was just part of aging." And yeah, to an extent, it is a natural part. But it doesn't mean that you have to live with it, right? Especially since there are some really good treatments now available.

Melanie Cole, MS: Well, thank you for saying that. So, tell us about some of the tools. there's so many tools, and we're talking today about PAE or prostatic artery embolization.

Dr. Jack Burt: Yeah. So, a newer tool in our toolbox to treat BPH is PAE. So PAE, what it stands for is prostate artery embolization. It's a modern and minimally invasive procedure, and it's performed by interventional radiologists, and it's used to treat BPH without the traditional surgery.

So instead of going through the urethra to cut or burn away prostate tissue, we perform prostate artery embolization entirely through the blood vessels of the body. So, embolization is just a fancy word that means stopping blood flow. So, we're essentially stopping the blood flow to the prostate in this procedure. And it's an outpatient procedure typically done with light or moderate sedation.

Melanie Cole, MS: Well, tell us about the benefits of this procedure and a little bit about the outcomes. What can men expect?

Dr. Jack Burt: Benefits are really what's led to its rapid growth nationally over the last few years. Patients are attracted to this surgery because there's no big skin incision. It's not a major surgery. There's nothing going through the urethra, and they're not going home with a Foley catheter or anything through the urethra after the surgery. There's a lower risk of bleeding. It's a same-day outpatient procedure with very quick recovery, and there's actually lower risk of sexual side effects like, erectile dysfunction compared to some other surgical options. So, most of our patients are back to normal activities within just a couple of days.

It's really attractive for males that are on blood thinners or who might have a very large prostate that can sometimes make surgical treatment difficult. And in terms of the effectiveness and the success, multiple studies have now shown that the majority of our patients are significantly improving their urinary symptoms as well as their quality of life within just a few weeks after the procedure.

Symptom relief can last for many months, even five years and beyond. So, very similar to other therapies. So, with that said, proper patient selection is very important. That's why we collaborate with our colleagues, the urologists.

Melanie Cole, MS: Now, you mentioned patient selection. So if somebody wants to investigate this procedure, how would they know that they might be considered a candidate?

Dr. Jack Burt: Basically, the first step is seeing us in clinic over here at Bryan Specialty Clinic. We do a detailed history and physical. We review your symptoms and score your symptoms and any prior treatments or imaging that you may have had.

Many patients have already tried medications like Flomax or others, and sometimes they didn't tolerate it or simply didn't get enough relief. We also work with our urology colleagues to make sure there isn't any underlying issue contributing to the symptoms other than BPH.

So, generally speaking, ideal candidates are men with bothersome urinary symptoms from BPH who want a minimally invasive treatment option.

Melanie Cole, MS: Wow. I mean, it really is amazing the technology. It's such an exciting time in your field. Where do you see BPH treatment going? What would you like to see happening? What's exciting in your field right now for men that are dealing with these symptoms?

Dr. Jack Burt: One of the most exciting things about medicine in general is being able to offer patients effective treatments that are less invasive than they were 10 to 15 years ago. And I think PAE is a really good example of that. You know, for the right patient, it can dramatically improve their quality of life, and that's what we're here to do, is to empower a patient and improve their quality of life.

Melanie Cole, MS: Well, thank you so much, Dr. Burt, for joining us and sharing your expertise to tell us about something that I think really men need to hear from you. They need to hear that this is not so scary, that this quality of life doesn't have to be this way, and that there are treatments available. So, thank you so much for joining us.

I'd also like to thank our Bryan Foundation partner, Pinnacle Bank. And to listen to more podcasts from our experts, you can visit bryanhealth.org/podcasts. And that wraps up this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole.