Dear Sirs,
I would like to give a patient’s point of view of the exciting curative opportunity PAE can offer, compared with surgery or long term drugs.
I had a PAE in June 2017. Previously, I had had 5 years of mild LUTS, controlled by lifestyle. But over two months I progressed to an IPSS score of 30+ and found myself in AUR. The pre-PAE MRI reported prostate volume at 116cc; no suspicion of carcinoma.
I was offered HoLEP but the downsides were 3 – 3 ½ hours under general anaesthetic; 3% need for repeat; 5% risk of a stricture (I was now catheterised); an outside chance of pulmonary embolism and/or stroke, and a 100% chance I would never ejaculate normally forwards again, I didn’t fancy the op.
I talked to a urologist with experience of 100+ PAEs. His advice: PAE fails in about 20% of cases but since I was actually in AUR, my chance of success was 50%. However, if I PAE failed, my worst case was that I would just have to do the HoLEP anyway; if PAE worked, I would have avoided HoLEP and its side effects and risks. I’d know within 3 weeks of doing a PAE whether PAE was working; I could go for a HoLEP if it wasn’t.
So, for me, PAE was what snooker players call “a shot to nothing”. If PAE worked, I’d retain, as a young and athletic 62 year old, full sexual function and avoid taking the risk a stricture or stroke/pulmonary embolism.
My interventional radiology (experienced in 50+ PAEs) advised after CT that I had simple vascular anatomy; access to my prostate would be easy; and my prostate was “adenomatous dominant”, a factor in recent successes: see the Little et al paper cited below. I decided to give PAE go for three months. My urologist changed my urethral catheter to superpubic, to put me in control of continuous trials for voiding. Cystoscopy photos showed I did not have middle lobe, nor a “ball valve” problem; these are other factors in recent PAE successes. My GP checked out the radiation risk I would expose myself to. In simple terms, it was calculated in my case as five summers in England, which I thought was very acceptable.
read more

A patient’s view of Prostate Artery Embolisation for benign prostatic hyperplasiaTreatment: Prostate Artery Embolisation