Prostatic Arter Embolization is Available at MUSC Health

Andre Uflacker, M.D.

Andre Uflacker, M.D., an MUSC vascular interventional radiologist who introduced the procedure at MUSC Health in 2019, says PAE is rapidly becoming an attractive alternative to surgery or medications for relief of nagging urinary symptoms.

“Patients are seeking us out and self-advocating,” says Uflacker, who trained with the international leaders pioneered PAE in Europe.

The outpatient procedure eliminates blood flow to the tissue within the prostate, shutting off the blood supply and ultimately causing the enlarged prostate to shrink.

Traditionally, men diagnosed with enlarged prostate have been treated with transurethral resection of the prostate, or TURP, long considered the gold standard, and medications. While both can have negative side effects, PAE can help avoid almost all side-effects associated with traditional surgical treatments, such as retrograde ejaculation and medication-associated dizziness.

“Because we’re going through the blood vessels and not the urethra, the approach is completely different and the side effect profile is different,” Uflacker says. “We’re simply blocking the blood flow; we’re not altering the artery or the anatomy of the gland. Surgery involves some instrument going into the penile urethra and destroying, shaving or removing tissue within the prostate surrounding the segment of urethra that goes to the prostate. We know it works quite well, but also that it can have undesirable side effects.”

TURP is usually performed under general anesthesia; whereas, patients undergoing PAE are sedated with IV medications.

With the aid of sophisticated CT technology that shows 3-D images of the patient’s anatomy on a computer screen in real time, Uflacker inserts a microcatheter into the femoral or radial artery and steers it to the blood vessels in the prostate. Once precisely placed, the catheter releases tiny particles made of polyethylene glycol that embolize, or block, blood flow to the prostate. He then repeats the procedure on the opposite side of the prostate.

“PAE is intricate and requires absolute precision to avoid damaging surrounding organs,” he says. “The catheters are about the size of angel hair pasta, less than 1 millimeter in diameter.”

The procedure can take one to several hours depending on the size of the arteries and the prostate. The prostate usually begins to shrink a few months after the procedure.

Uflacker works closely with urologists, who screen benign prostatic hyperplasia patients for cancer and good bladder function and counsel them on their treatment options, including PAE. “We want to provide the best option for the patient that fits their needs,” he says. “As a result, not every patient is recommended for PAE.”

He does a CT scan on his patients to determine if they have healthy vessels, which are essential to undergo PAE.

“Patients who smoke and have plaque or hardening of the arteries or whose bladder can’t pump the urine may not be candidates for PAE,” he says. “It’s important to screen patients for things like diabetes and Parkinson’s disease.”

He is encouraged by PAE outcomes and optimistic about the potential for PAE to treat benign prostatic hyperplasia. A recent meta-analysis of more than 1,200 patients showed that PAE can reduce the IPSS score by 23.5 points and the Quality-of-Life score by 4.7 points at 12-month follow-up. Both scores are extremely important proxies of how well a man can urinate, and how happy he is overall with regard to these symptoms.

“PAE has proven to be a great option for men with large prostates, bigger than 100-120 grams, because surgery becomes less viable as prostate size increases. They tend to do pretty well, similar to men with smaller prostates,” he says.

“The effect on the prostate is permanent. We do know that the results have held consistently at two and three years after the procedure.”