Requirements for a Candidate

Not every patient is a candidate 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 is usually achieved by blood tests, rectal examination and possibly biopsy. The following are approximate guidelines for inclusion:

Inclusion criteria

• Age: 50-80 years old
• Prostate volume: > 40ml and preferably >60ml
o Prostate size is determined during an ultrasound examination performed either by the urologist during a clinic visit, or via the radiology department
• 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) >18
• Urine flow rate <12 ml/sec, determined during Urology visit.

Exclusion criteria

• Renal (kidney) failure
• Bladder failure
• Bladder diverticulum
• Bladder stone
• Severe atheroma or ectasia, assessed during work-up.
• Active infection
• Proven prostate carcinoma (see above)

All patients who are being considered for Prostatic Artery Embolization require a CT (computed tomography or ‘cat’ scan) 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 essentially has a ‘map’ of the arteries. This means that during the procedure, less radiation is used which reduces the time needed thereby improving safety to the patient and making the procedure more tolerable to the patient.

Expected outcomes after PAE

PAE offers patients an adjunctive management strategy when faced with troublesome symptoms of lower urinary tract symptoms. Not all patients respond 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 is an integral role player in the decision-making process.