- Successful trial in Portugal being followed up in UK with results due this year
- If it is successful the technique could be rolled out for routine use on the NHS
- Researchers expect it to largely replace surgery as the standard treatment
Tens of thousands of men could benefit from a breakthrough prostate treatment announced today. The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation. A successful trial in Portugal is being followed up in Britain, with results due back later this year. If successful it could be rolled out for routine use on the NHS.
Last night, researchers said they expected the new technique – prostate artery embolisation – to largely replace surgery as the standard treatment. An enlarged prostate presses on the bladder, while also blocking the urethra. This means sufferers need to make repeated night-time trips to the toilet, often to find they cannot urinate at all. This can lead to a build-up of toxins that cause severe kidney problems. The bead technique has been tested on 1,000 middle-aged men in Portugal.
Joao Martins Pisco, who led the study at St Louis Hospital in Lisbon, said: ‘Within five years I think this will replace surgery as the standard treatment. Time and time again, I see patients who are relieved to find out about prostate artery embolisation because they are not able to tolerate medications due to their side effects. ‘These men also don’t want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to prostate artery embolisation, which is generally performed under local anaesthesia and on an outpatient basis.’
The Portuguese team, which will present its findings at the Society of Interventional Radiology in Washington DC today, concluded the procedure is as effective as surgery and the half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it. Only two patients in the seven-year trial had clinical side effects.
Performed under local anaesthetic, the procedure involves injecting hundreds of 0.2mm plastic beads into an artery in the groin. The beads are directed with a thin tube into the blood vessels that flow to the prostate, blocking blood supply to the enlarged gland so that it shrinks.
Dr Pisco added: ‘I have had nine babies born to men who were able to continue their sex lives after having the treatment.’ His team saw a 89 per cent success rate six months after surgery, 82 per cent success up to three years, and 78 per cent beyond three years. Two hundred patients in Southampton General, Guy’s Hospital in London and 16 other clinics are involved in the British trial, which is part-funded by the clinical watchdog NICE.
Dr Nigel Hacking, who is leading the study, said: ‘It is very encouraging. I am always cautious about new techniques but this procedure seems to be showing promise and it seems to be safe.’ Louise de Winter of the Urology Foundation said: ‘This research is very exciting. ‘As the population ages these problems are going to get even more acute.’ An estimated 45,000 men undergo surgery for enlarged prostates every year in the UK. Dr Pisco claims most of these could be replaced by prostate artery embolisation – although others say the less invasive procedure is not be suitable for all men, and many will have to continue to have surgery.
Two hundred patients in Southampton General (pictured) Guy’s Hospital in London and 16 other clinics are involved in the British trial. Dr Hacking said that in his own experience, roughly 40 per cent of patients who have embolisation later have to undergo operations. But having initial embolisation may enable them to delay that operation while retaining sexual function, and this usually means that when they do come to have an operation it is less invasive and there is a lower risk of side effects. ‘Even if they do need to go back and have surgery it’s a smaller operation,’ he said. Dr Hacking said it was unlikely the procedure will completely replace surgery, because it requires a highly trained interventional radiologist. ‘It is a fiddly procedure and it would be potentially dangerous for someone without the skills to do it,’ he said. ‘But I think it may give men another option alongside surgery.’
Surgery, conducted either with a hot wire or lasers, have a high success rate – but they come with side effects which can include loss of sexual function, bleeding and incontinence. The symptoms of enlarged prostate include a frequent need to urinate, but also difficulty starting to urinate and difficulty fully emptying a bladder. These symptoms, however, also might be a sign of prostate cancer, so anyone in this way should be seen by a urologist.
By Ben Spencer Medical Correspondent For The Daily Mail