Prostate Artery Embolization
What is Prostate Artery Embolization (PAE)?
PAE is a minimally invasive, outpatient procedure for treatment of BPH and has been performed since 2014 in our practice, as long as any other in the United States. The procedure is performed through a catheter smaller than 1/16” through the artery in the wrist. The catheter is directed by x-ray to the arteries feeding the prostate and blocked off with microscopic particles. This process, called embolization, the prostate to shrink about 50%.
Experience Matters
Drs. Cliff Davis and Justin Lee were among the original physicians performing PAE in the United States. Dr. Davis has taught the procedure to numerous physicians over the past 5 years and proctors courses at our largest hospital, TGH, for physicians interested in learning the techniques. Dr. Davis is also the Principal Investigator of an FDA and CMS approved trial on PAE located at TGH. He has been appointed to lead a national research panel on PAE by the Society of Interventional Radiology and continues to hold that position.
Who gets PAE?
Prostate artery embolization (PAE) is a promising new procedure for patients suffering from symptoms of Benign Prostatic Hyperplasia (BPH) – but is not a treatment for prostate cancer at this time.
How is it performed?
PAE is performed through the radial artery in the left wrist through a small catheter directed to the tiny arteries that feed the prostate. Microscopic particles are then used to block of the blood supply to the prostate (called embolization). The procedure is performed under light sedation without placement of a foley (urinary catheter), total procedure time is 45-90 minutes. Patients can walk and eat within a few minutes of the procedure. Total time in the hospital is about 6 hours and patients are discharged home with anti-inflammatories, pain medication and antibiotics.
What is the recovery time?
Post-procedure symptoms typically last about 3 days and includes pain during urination, mild pain at the base of the penis. Most patients still carry out their daily routine after 1-2 days.
Are their risks of erectile dysfunction?
Recent research studies evaluating the risks have shown no risk of erectile dysfunction and less than 1% of serious complications. Some patients have actually had improvement in their erectile dysfunction in some studies.
What is the evaluation process?
Prior to performing the procedure all patients must have to have a recent appointment with a urologist to evaluate for signs of prostate cancer and assure the patient’s symptoms are caused by prostate enlargement. Several diseases involving the urethra and the bladder can mimic symptoms of BPH which will not be improved with prostate artery embolization. If you have not had those tests recently, we may request you have an appointment with a collaborating urologist at Tampa General Hospital to assure we feel you are a good candidate.
How do I get started on the evaluation process?
Potential patients can contact our PAE coordinator at PAE@tgh.org or call at 813.844.5072. Once our coordinator receives your information we will contact you to give us permission to collect your records. We will be contacting your urologist to obtain records which may be quicker if you ask for them directly.
Benign Prostatic Hypertrophy Clinical Study Treatment
Florida Interventional Specialists, in cooperation with Florida Urology Partners and the University of South Florida, has been involved a study on an exciting treatment for benign prostatic hypertrophy (BPH) since 2014. BPH affects approximately 50% of men at the age of 60 and 75% of men at the age of 80. Symptoms of BPH, called Lower Urinary Tract Symptoms (LUTS) can often be controlled with medications but many patients have worsening symptoms despite the best medical care. In many of these patients, quality of life suffers and patients have difficulty sleeping due to nocturia (waking to urinate).
Dr. Clifford Davis, of Florida Interventional Specialists, has designed a study utilizing Prostate Artery Embolization (PAE) for BPH specifically for patients at Tampa General Hospital. FIS is one of only a few practices in the country that have their own FDA approved IDE (investigational device exemption) for the treatment of BPH with PAE. Although several other institutions are performing PAE, most are not FDA approved. The IDE approved study means that experts at the FDA reviewed the study protocol and made recommendations to make the study the most beneficial and safe for enrolled patients. This study is specifically for patients with large prostates that would require more invasive surgery for treatment. PAE offers these patients a less invasive treatment option or possibly the only option in patients with high risks for surgery. The study is designed to evaluate the safety and efficacy of the procedure and is not randomized; all patients that meet study criteria will receive Prostate Artery Embolization. In this study the procedure and tests will be billed to insurance and if the insurance company will not authorize the treatment, the hospital may request payment prior to the procedure. Billing for this procedure is handled on a case by case basis PRIOR to any treatment.
More information regarding the studies can be found here: http://clinicaltrials.gov/show/NCT02167009
FAQs
Depending on when the biopsy was performed and your PSA level we may require a repeat biopsy. Some patients may be candidates to receive a prostate MRI which is a non-invasive way to evaluate the prostate size and signs of cancer. That procedure is not paid for by insurance, however, our practice has partnered with a local MRI center to offer the prostate MRI self-pay for $500.
YES, obtaining your outside records will significantly decrease the time it takes to review your history and determine if you are a candidate. Filling out the forms online and submitting them with as much information as possible will also expedite your screening.
Yes, in fact several studies have shown that patients with urinary retention are well treated with embolization and have minimal side effects.
Depending on the type of surgery, you may still be able to get PAE. Please fill out the patient forms and submit them to our office and we will contact you regarding your history within one day.
Post procedure symptoms include pain at the base of the penis, pain during urination and possibly a small amount of blood in urine/stool. On average, these symptoms last 2-3 days but can continue up to 5 days.
Although there are no guidelines, we recommend abstaining from sex for 2 weeks after PAE. The prostate and the seminal vesicles, which share blood supply with the prostate, develop much of the fluid in semen. Pain may be increased during sex if performed during the first week after PAE.
Yes, after review of your medical record and a discussion with you, we will determine if you need additional testing. We will also discuss the research studies we are involved in and screen you for them. Most of the testing before the PAE can be done at our center within a few days of the procedure.
Yes, but we will need to review why you are on blood thinner to determine if it is safe to stop them for 1-2 days.
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