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Less-invasive prostate surgery available

CHICAGO ― A new minimally invasive procedure designed to shrink the prostate could offer an alternative to surgery for a benign condition that affects millions of men in America.

However, doctors cautioned that the benefits found in the small clinical trial presented here need to be duplicated in a bigger, more rigorous study.

“The main thing they are showing is that it is safe,” said William Rilling, medical director of interventional radiology at Froedtert Hospital in Wauwatosa, Wisconsin, who also is a professor of radiology and surgery at the Medical College of Wisconsin.

The procedure, which causes the prostate to shrink by cutting off blood supply, is done under local anesthesia. Known as prostatic artery embolization, it uses a catheter through an artery in the groin to place tiny particles into prostatic arteries.

The study, which was done by doctors in Portugal, involved 84 men age 52 to 85 who were followed for an average of nine months.

The researchers said 77 men showed excellent improvement, six had slight improvement and one had no improvement.

In some cases, urinary problems improved within two hours of the procedure.

One potential problem is that the procedure seemed to be less effective in men who had advanced artery disease, which also is more common in older men.

The results were presented Tuesday at the Society of Interventional Radiology annual meeting.

As men reach their 40s, the prostate begins to enlarge, causing it to press against the urethra. The condition is known as benign prostatic hyperplasia, or BPH. By age 60, up to 50 percent of men have symptoms involving urine flow, such as frequency and urgency.

An estimated 19 million men in the United States have symptomatic BPH.

The condition often is treated with medication, but in some cases surgery is needed, though it can cause significant side effects.

The gold standard surgical treatment, transurethral resection of the prostate, can cause sexual dysfunction, urinary incontinence and blood loss.

“This will be the future for BPH,” said lead author Joao Martins Pisco, director of interventional radiology at St. Louis Hospital in Lisbon. “I don’t have any doubt about it.”

Doctors in the U.S. said the procedure has garnered more attention in Europe, though U.S. physicians now are traveling to Portugal to study it.

“We are really just learning about it,” said James Spies, chairman of radiology at Georgetown University Medical Center. “I would hesitate to say it looks like a panacea, but it is very promising.”

Another issue is whether urologists, often the physicians who treat BPH, will accept the therapy if it is approved in the U.S.

Already, several less-invasive surgical approaches are available to treat some men with BPH, noted Matthew Johnson, a urologist who practices at Aurora St. Luke’s Medical Center in Milwaukee.

“Urologists are open to any and all legitimate options, even when the option would reduce the number of surgeries performed,” Johnson said. “This is the only way progress is made in medicine.”

Pisco’s results were based on symptoms nine months after undergoing the procedure.

Marshall Hicks, a professor of diagnostic and interventional imaging at the University of Texas MD Anderson Cancer Center in Houston, said rigorous, longer-term data comparing the procedure with other therapies will be needed before it will be accepted in the U.S.

By John Fauber

(Milwaukee Journal Sentinel)

(McClatchy-Tribune Information Services)
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