Benign Prostatic
Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH)
also called benign prostatic enlargement (BPE)
is a common condition as men get older.

An enlarged prostate gland can cause
uncomfortable urinary symptoms, such
as blocking the flow of urine out of the bladder.
It can also cause bladder, urinary tract
or kidney problems.

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Dr. Silvia Giuliani – interventional radiologist
San Camillo Forlanini Hospital, Roma, Italy

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Treatment options

Initial evaluation and Surveillance

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When a man develops BPH, it is recommended to reach out to a general practitioner for initial evaluation that can include:

Family history evaluation: Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.

The IPSS score: International prostate symptoms score to find out how bad the patient urinary symptoms are and how much it is affecting his life. Patients are stratified according to 3 categories [0-35 range]: Mild symptoms (0-7), moderate (8-19) and severe (20-35).

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Digital Rectal Examination (DRE): Because of where the prostate is located, the doctor inserts a gloved, lubricated finger into the rectum to check the size of the prostate and assess if there are any abnormalities.

Medical therapy

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A man with BPH may benefit from medical therapy.

The practicing urologist decides of the most appropriate medication for the patient. Common medication for BPH fall into two categories:

• 5 alpha reductase inhibitors, which in turn decreases the production of the hormone (dihydrotestosterone) responsible to BPH.

• Alpha blockers, whose action is to relax the smooth muscle in the prostate and in the neck of the bladder, thereby decreasing the blockage of urine flow.

Transurethral resection of the prostate (TURP)

Operation

When a man with BPH (from moderate to severe symptoms) is refractory to medical therapy, the surgery comes as an alternative treatment.

A common surgery to treat BPH is Transurethral resection of the prostate (TURP). The doctor removes portions of the prostate that are affecting the urine flow.

There is no cutting and no external scars since a surgical device is inserted through the urethra to remove the lesion (hyperplasic tissue).

Minimally invasive treatment (MIS)

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When a man with BPH (from moderate to severe symptoms) is refractory to medical therapy, the surgery comes as an alternative treatment.

The image guided therapy using prostate artery embolization (PAE) technique is a minimally invasive treatment that is performed in an operating room by an interventional radiologist.

PAE is a selective and targeted therapy enabling the injection of very small beads (micrometer range) that embolize the prostatic arteries. This conducts to the stopping of lesion blood flow finally leading to the lesion shrinkage over the time.

During PAE, X-ray guidance is used to navigate a delivery tool(microcatheter) into the prostate arteries, via a pinhole in the wrist or groin.

Prostate Artery Embolization (PAE)
A minimally invasive procedure to treat BPH

Main advantages
Local anesthesia, possibility to keep antiplatelet/anticoagulant therapy,
in general discharged the day of the treatment

Clinical outcomes

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Up to
-12.8 points
improvement in IPSS score*

-2.3 points
in quality of life in average *

Tips to understand these clinical outcomes

As a reminder: IPSS score is a tool used to find out how bad a patient urinary symptom is.

The score scales from 0 to 35 points and patients are stratified as follow:

Mild [0 – 7]
Moderate [8-19]
Severe [20-35]

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*Source: Shim SR, Kanhai KJ, Ko YM et al. Efficacy and Safety of Prostatic Arterial Embolization: Systematic Review with Meta-Analysis
and Meta-Regression. J Urol 2017 ; 197 : 465–479

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What is International
Prostate Symptom
Cancer (IPSS)

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What is International
Prostate Symptom
Cancer (IPSS)

The IPSS questionnaire allows your urologist to better understand the severity of your urinary symptoms. Understand your symptoms by taking this short quiz

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