The I-MED Radiology Network team spoke to Dr Nick Brown, Clinical Director of I-MED Radiology at The Wesley Hospital, about the improved options for patients suffering from enlarged prostates.

How long has Prostate Artery Embolisation (PAE) been performed at The Wesley Hospital? 

The first PAE was performed at The Wesley Hospital in 2015. Since then, our PAE treatment program has grown to be one of the largest in Australia and New Zealand, and forms part of successful collaboration between urology and interventional radiology. 

Can you tell us a little about PAE, what is it exactly and why is it important for patients? 

PAE is a non-surgical, interventional radiology treatment that blocks-up the blood flow to the prostate. This causes the prostate to shrink and relieves urinary obstruction, leading to improved urine flow, improved bladder emptying and improved overall quality of life. The treatment is usually completed as a day-case with a faster recovery and fewer adverse outcomes compared to surgery. PAE provides men suffering from enlarged prostates with a non-surgical treatment option that can reduce their symptoms. While there is no way to cure this problem, PAE can help to delay, and sometimes avoid, the need for invasive surgery. The treatment has many advantages compared to other forms of treatment: it has fewer potential unwanted side-effects; it can be repeated; it does not require a catheter; and it does not take away any future treatment options. In short, it has given men with this problem more options to choose from.

How has the research performed at The Wesley Hospital improved patient outcomes? 

The interventional radiologists at The Wesley Hospital have worked with urologists to perform several clinical trials investigating PAE. These have confirmed the benefits of PAE and also led to a world-first trial that showed PAE provides better results than current standard medical therapy used as first-line treatment. This means that PAE could be considered as an alternative early treatment for enlarged prostates and may help to slow down the progression of this condition. This research has expanded the non-surgical treatment options that may lead to improved quality of life and reduced symptom severity.

What is the significance of the PAE research that has been conducted at The Wesley Hospital? 

Our research will hopefully lead to a change in the Australian and New Zealand guidelines for treating enlarged prostates, to allow all men suffering from this condition to be able to consider expanded treatment options and choose the right one for them. While it is included in treatment guidelines in Europe and the United States, PAE is still unavailable in many hospitals in Australasia. 

Why did the Wesley Interventional Radiologists decide to establish a PAE program? 

Prostate enlargement is a very common problem that will impact most men at some stage in their lives. Although it is a very different problem compared to prostate cancer, it can still have debilitating impacts on men’s quality of life, and if ignored can lead to bladder and renal dysfunction. Surgical treatments for prostate enlargement, while effective, can be associated with unwanted side-effects such as impacts on sexual function, urinary incontinence and the use of a urinary catheter. PAE is a non-surgical treatment option that typically provides several years of improved quality of life without those significant impacts.

Who performs PAE? 

PAE is performed by highly trained, specialised interventional radiologists. It takes many years of training and experience to become a suitably qualified interventional radiologist. 

What's the most surprising or unexpected thing about working in PAE? 

The extent to which men are prepared to put up with the adverse effects of having an enlarged prostate, and delay seeking treatment, is a surprisingly common trait. Many men live with an enlarged prostate, and compensate for it, for many years before seeking treatment. It is good urological advice for men to seek treatment early and to prevent worsening. It also provides a great opportunity for men to be screened for prostate cancer. 

What are the common misconceptions about interventional radiologists that you'd like to debunk? 

Interventional radiologists (IRs) are clinical specialists who work within a multidisciplinary team to provide minimally-invasive treatment options for patients. Although IRs are dual-trained, as specialist diagnostic radiologists as well, IRs work very differently to their diagnostic colleagues. Ward rounds, outpatient clinics and caring for inpatients are all regular occurrences in the life of an IR, and critical for the provision of modern clinical care. 

For more information, speak to your doctor and learn more about PAE.