Check Suitability for PAE
Lower Urinary Tract Symptoms (LUTS) are very common in men over 45.
Not every patient is a candidate for PAE and strict inclusion criteria are evaluated prior to embolization.
The patients are always seen by a urologist who makes the diagnosis of BPH and excludes underlying cancer. This can be your usual Urologist or Dr Hacking can arrange for you to see a Urologist with experience of PAE.
The diagnosis is usually achieved by blood tests, rectal examination and possibly MRI or biopsy.
The following are approximate guidelines for inclusion:
• Age: 45-80 years old
• Prostate volume: > 40ml
• Prostate size is determined during an ultrasound or CT examination performed either by the urologist during a clinic visit, or via the radiology department at time of your initial consulation
• Blood test: PSA (prostate specific antigen) <4 or, if higher, assessed for cancer with rectal exam and biopsy,
• International Prostate Symptom Score IPSS (symptom score) >8 (Moderate to severe symptoms). IPSS link
• Urine flow rate <12 ml/sec, determined during Urology visit.
• Renal (kidney) failure
• Bladder failure
• Large Bladder diverticulum
• Bladder stone
• Severe atheroma or ectasia, assessed during work-up.
• Active infection (Urinary Tract Infection or Prostatitis)
• Proven prostate carcinoma (see above)
All patients who are being considered for Prostatic Artery Embolization require a CT (computed tomography angiogram) of the prostate during their workup.
The role of the CT scan is the following;
• Identify the number of prostate arteries,
• Identify the origin of these arteries
• Exclude diseased blood vessels leading to the prostate arteries.
Once this data is available, the interventional radiologist can use this as a roadmap of the arteries. This allows a quicker procedure, with less radiation so improving safety and comfort for the patient.
What to Expect after PAE
PAE is a very effective (80% plus) treatment of the bother of lower urinary tract symptoms.
Not everyone responds equally to PAE. The worse the severity of the disease, the better the reported outcomes. Not all patients are suitable for PAE and when deciding on how to manage your BPH it is vital that your urologist and Interventional Radiologist guide you through the decision-making process.