Transcription:
New Options for Treating an Enlarged Prostate

Introduction: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole: Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and today we're examining new options for treating an enlarged prostate, prosthetic artery embolization. Joining me in this panel are Dr. James Hill and Dr. John Patrick Gonzales. They're both Interventional Radiologists and members of the medical staff at Henry Mayo Newhall Hospital. Gentlemen, thank you so much for joining us. Welcome to the show and Dr. Hill, I'd like to start with you, give us a little kind of working definition. What happens to the prostate as men age and what are some of the symptoms of prostate trouble?

Dr. Hill: Yes, so, you know, as some men age, the prostate can grow in size and some of it can be due to these hyperplastic nodules, which are basically just benign growths of tissue. And as that prostate grows in size, it just compresses the outlet of the bladder as a urines, trying to exit the bladder and out of the body. And that just creates difficulty with urination. And, you know, men can have difficulty starting urination. They can have incomplete voiding, they may need to wake up multiple times during the night to urinate. Sometimes they can even have discomfort with urination. And so, yeah, this is a problem that many men encounter as they age.

Dr. Gonzales: I just want to add, in addition to what Dr. Hill mentioned, the prevalence of this disease is around 70% of men, older than 70 years of age. And one fourth of men over 70 years have moderate to severe symptoms and the symptoms are exactly what Dr. Hill mentioned.

Host: Well, thank you for that. So, Dr. Gonzales, thank you for telling us about the prevalence of it. Cause it is so common while you're speaking of that. Is this just a normal part of aging? Tell us a little bit about BPH. Do most men experience it at some point? Is it normal for this to happen? Tell us a little bit about BPH.

Dr. Gonzales: Sure. It's basically a result of proliferation or growth of the glandular or stromal tissue, and what's called the transitional side of the prostate and it's not something that's normal per se, but it happens in most men and it's associated with getting older and it's something that isn't necessarily present in everyone. You know, it is basically an abnormality, but it is just very, very common. And so we associate it with the people getting older the same way people's joints start aching when they get older, it's not something normal, but we tend to think of it as being normal in a sense, because it just affects so many people.

Host: Dr. Hill tell us about screening. We've heard about PSA and digital, which is one of the reasons men don't like to go see their urologist in the first place, right? Because they're afraid of whatever the examinations going to entail. But tell us a little bit about the screening. What happens if BPH is left untreated and while you're discussing some of that, tell us how you stratify symptom burden. Before we get into talking about prostatic artery embolization, how do you stratify if these symptoms are severe enough to require treatment?

Dr. Hill: Well, that's an excellent question, you know, and I know this can be an uncomfortable topic for many men, but as Dr. Gonzales was saying, it's an extremely common problem that, you know, so many men face as we're getting older, you know, and most of what we're looking at is, is your symptoms. Most men will want to be treated by a urologist and followed by a urologist who, you know, are male reproductive specialists. And, you know, they, they have a bevy of questions and also, you know, diagnostic tests that kind of track the flow and track how your symptoms are doing. And, you know, the most important of those for us to kind of stratify where patients are on the spectrum of this disease is what we call the International Prostate Symptom Score. And it's a very simple questionnaire. And we basically ask you about seven questions and based on the scoring of those questions, we can put you in either a mild, moderate or severe category.

And the questions are just about how much are you emptying? Is a complete? How often are you having to go to urinate? Do you have an intermittent stream? Do you feel urgency? Do you have a weak stream? Are you straining to stream? And then how many times a night do you have to get up to go to the bathroom? So once we put you in those, you know, mild, moderate to severe categories, we can kind of see if you are someone who can maybe, you know, see how we're doing, and we can even treat you with some medications to improve the flow. But once you've kind of reached a point where the medications either aren't working or we've maxed out, you know, the medications that we can give you, patients that are basically what we call it, a symptom score above 12, or, you know, a strong, moderate, they may be a candidate for therapy to get them to a more comfortable place in their life. And that's when we consider referring them for a procedure.

Host: So, Dr. Gonzales, then tell us about the procedure. Tell us about prosthetic artery embolization. What is it? Who's a good candidate and also is it FDA approved?

Dr. Gonzales: Sure. So basically the procedure is what's called a minimally invasive procedure that entails image guidance. It's a procedure that's performed by interventional radiologists, such as myself and such as Dr. Hill that basically used imaging specifically, x-ray or fluoroscopy, to help guide a very small tube called a catheter either through the wrist or through one of the larger arteries in the groin. It's guided towards the prostate gland itself. And what we do is we inject the dye through the bloodstream that helps create a roadmap that we can follow to guide this little tube towards the prosthetic arteries. And each person has two arteries, one on each side of the body. And the goal is to basically limit the blood flow to the prostate gland to encourage it or to cause it to shrink. And the way that blood flow is altered or blocked is by injecting tiny beads that basically travel with the bloodstream towards the prostate gland. And they eventually plug up the small arteries that supply the prostate gland. In terms of it being FDA approved, FDA doesn't really approve procedures, but they approve devices and drugs. So there are devices, or in particular, the beads are FDA approved for use in prosthetic artery embolization. So we do use FDA approved products and performing prosthetic artery embolization.

Dr. Hill: That's absolutely correct. In addition to that, you know, I just wanted to say that's a, that's a wonderful explanation of the procedure. I think the approval from the FDA happened in June of 2017 and Dr. Gonzales was saying, this is, you know, an FDA approved device specifically for this. And you know, this procedure as he described, it has actually been used for, for 50 years now, but originally it was used to control bleeding from the prostate from a number of different reasons. And over time, they kind of discovered that, Hey, you know what, these patients are getting relief of their obstructive prostate symptoms as well. And that's how this procedure came to be patients that were getting treated for bleeding actually had some improvement of their other obstructive BPH symptoms as well. And over the last 20 years or so, we've been gathering lots of data showing that the procedure works.

Host: Well, thank you both for that. So Dr. Hill, tell us a little bit, you're both interventional radiologists. Listeners may not know what that does, what that is. Tell us a little bit about your field and what an interventional radiologist really is? Is this considered a surgical approach? Give us a little bit more information, expand a little for us.

Dr. Hill: That's a great question. One that we often receive. So interventional radiologists is a board certified physician who did a generalized internship and then a residency in radiology and then a specialty of fellowship in image guided procedures. So we do a vast array of image guided procedures, and this is one of them. Many of them are these catheter-based procedures in the arteries and veins. We do many other procedures treating tumors and other image guided procedures, but this is one of the areas of specialty. And as we are basically termed minimally invasive specialists. So this is not a surgery, it's a minimally invasive procedure. And by that, what we mean is, you know, there's really no incision like Dr. Gonzales was saying, we thread this tiny micro catheter inside the arteries in order to get to the prostate arteries and inject these teeny tiny little particles to fill up the prostate arteries. And once we're done, you know, we pull the catheter out and put a tiny plug on top of the artery. And then there's about a three, four hour time window where you're in recovery. And then you're able to go home the same day. So, you know, one of the benefits of being able to treat the prostate like this in a minimally invasive fashion is that the recovery is much shorter and usually easier. There is no hospitalization required. Now you do get to go home same day, which is a nice alternative.

Host: Well, it certainly is. And Dr. Gonzales tell us if someone wants to come in and have this procedure, if they're considering it in light of what we've got going on right now, they may be nervous about COVID tell us how you're keeping your prosthetic artery, embolization patients safe from COVID-19. How are you going about it? What's it like for them right now?

Dr. Gonzales: Sure, absolutely. Right now, because of what's going on with the pandemic, everyone's concerned about safety. And so right now, the hospital Henry Mayo is screening all the employees as they enter the hospital. So there are temperature checks. They screen them for symptoms of COVID-19 and everyone's required to wear a mask inside the hospital. So when patients do schedule procedures or if they come into the hospital for procedures, they'll undergo the same screening that the employees undergo. And in addition to that, they're also tested for COVID-19 beforehand. So anywhere from three to seven days before a scheduled procedure, there'll be tested and that's to ensure that no one enters a hospital that might put other patients at risk or employees at risk who might then put other patients at risk of contracting COVID-19. In addition to that, when patients are in the hospital, the hospital staff tries to adhere to social distancing guidelines, as much as possible. We use all the CDC recommended disinfectants to both clean the room and the equipment before and after equipment is used on patients. Most of the equipment we use is also a single use and disposable. So we're not reusing equipment on patients after being used on someone that might potentially have some infectious disease.

Host: Dr. Hill last word to you. If someone is considering this procedure, please tell them how soon they can get back to their regular activities? What they can expect as far as results? Kind of sell it for us, let us know what you want listeners to take away from this really fascinating procedure that can help so many men with the symptoms of benign prostatic hyperplasia.

Dr. Hill: Let me tell you a little bit about, you know, the effectiveness of the procedure. So the good news is in the, in about the last 20 years, you know, people have been doing randomized controlled trials and gathering data just about does this and how well does it work? And, you know, and the good news is of what we found is that the important category is that it does, the results are almost identical to that, of our current surgical treatments, which are known as a Terp. And so they've done some trials looking at the comparison between the two, you know, and what they found is that over time, both the peak flow rate, which is, you know, the speed at which your, it comes out of the bladder and also the amount of urine that's left over in the bladder, that can't be urinated out, both of those improve at the same rate. And so it is a, you know, a comparative alternative to the current surgical standard of care. They also look at patient's symptoms scores before and after the procedure. And those are also nearly identical to surgery over time.

And what they found is that on the average, the patients that they've treated, you know, go from a score of how bad their symptoms are of a severe all the way down to a mild, which ends up being with a quality of life score, where there, you know, happy with their quality of life after the procedure. And the other part of this procedure is like we were talking about, since it is minimally invasive, you know, you will be out of the hospital same day after about a three to four hour bed rest timeframe. And, you know, the recovery we do ask that you refrain from a vigorous exercise or heavy lifting for about three to five days. Patients may experience some discomfort for a couple days. They may even experience about, you know, two days of temporary worsening of their prostate symptoms before they start seeing the results. The results, you know, do start happening within the first couple of weeks. And they continue to improve over six months, even out to two years, the results do continue to improve.

Dr. Gonzales: In addition to what Dr. Hill mentioned, what advantage of the prosthetic artery embolization procedure, as opposed to the traditional surgeries, is that it's the risk of major complications is significantly lower because it is a minimally invasive procedure. It doesn't involve large incisions and you do away with a lot of the complications that could arise from that. So comparing prosthetic, Artery embolization to the standard surgical treatments, the risk of major complications such as bleeding is much, much less. So it is a safe procedure. There are some complications like any procedure, you know, we can't a hundred percent eliminate that, but their rate of complications is significantly lower than that, of traditional surgery.

Dr. Hill: Thank you, Dr. Gonzales. So, you know, in addition to that, I'd just like to mention specifically that, you know, one of the facets that patients do like and are drawn to about this procedure specifically is that there are almost no risk of sexual side effects that can be seen in some of the other treatments for this procedure, such as erectile dysfunction or urinary incontinence. And that's one of the more attractive facets of this procedure for some patients.

Host: Well, that is such a great point to make. And thank you so much, gentlemen, for coming on and telling us about this very interesting procedure that really can help so many men with those symptoms of BPH. Thank you again. And to learn more, please visit Henrymayo.com/PAE. Or you can call (661) 200-1650 to get connected with one of our providers. And that wraps up this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please remember to subscribe, rate, and review this podcast and all the other Henry Mayo Newhall Hospital podcasts, and share this show with friends that, you know, share on social media, because that way we're learning from the experts at Henry Mayo Newhall Hospital together. This is Melanie Cole.