Doorbraak in prostaat-therapie
April 18, 2018 -
Een nieuwe procedure – prostaat-embolisatie (PAE) – is in april door de NICE, het nationaal instituut voor gezondheidszaken van Engeland, goedgekeurd. Naar verwachting zal deze goedkeuring gezondheidsautoriteiten in heel Europa aanzetten de procedure te adopteren.
Brazilië en de Verenigde Staten keurden de PAE-therapie in respectievelijk 2016 en maart 2018 goed. Bij de procedure worden microbolletjes gebruikt om de bloedtoevoer te beperken waardoor een vergrote prostaat krimpt. Het biedt mannen hiermee naast een operatie een nieuwe behandeling.
An enlarged prostate presses on the bladder, while also blocking the urethra. Sufferers need to make repeated night-time trips to the toilet, but often find they cannot urinate at all. The condition, known as benign prostatic hyperplasia (BPH), affects about 50% of men over the age of 50, rising to 75% over 80, although not all affected men experience symptoms.
PAE therapy, performed by an interventional radiologist rather than a surgeon, is an alternative to transurethral resection of the prostate (TURP), an operation to shrink excess prostate tissue that is blocking urine flow.
PAE involves guiding a 1mm flexible tube known as a micro-catheter, under local anaesthetic, into the femoral artery in the groin and then in to the prostatic arteries, aided by sophisticated 3D X-ray technology to ensure accurate positioning.
Once in place, the arteries are blocked by injecting a solution of microscopic particles -- 0.2mm plastic beads -- which partially reduce the blood supply. The reduction in blood supply induces the gland to shrink in size over time.
The procedure is quick — PAE takes approximately 2 hours to perform, and the patient can be discharged after 4 hours provided he is fit, whereas surgery may require an overnight stay or longer. PAE also eliminates some of the common side effects of TURP, such as sexual dysfunction, infertility and transient incontinence.
PAE was first described in 2000, but gained popularity when Dr Francisco Carnevale published his first cases in 2010, since when it has been the subject of several studies, notably in Brazil, Portugal, China and the UK. Dr Carnevale is based in Sao Paulo, Brazil.
At St Louis Hospital in Lisbon, Portugal, a team led by Dr João Martins Pisco performed PAE on 1,000 patients over a nine-year period, with long-term success rates of 78 percent.
Dr Nigel Hacking, one of the world’s leading interventional radiologists, led the first pilot studies in the English speaking world and was the clinical lead for the work of the multicentre UK Registry of Prostate Embolisation (UK-ROPE) which published its findings in April 2018.
The study led to the approval by NICE (National Institute for Health and Clinical Excellence) for PAE in April 2018. The NICE approval is now expected to encourage health authorities to adopt the procedure throughout Europe. Brazil and the U.S. approved PAE therapy in 2016 and March 2018 respectively.
In February, Dr Andrew Lawson, under the supervision of Dr Hacking, performed four PAE live demonstrations at Netcare Sunninghill Hospital in Johannesburg, South Africa.
In March 2017 Co-conveners Dr. Nick Brown, Dr. Duncan Walker and Dr. Glen Schlaphoff held the first PAE workshop in Brisbane, Australia and PAE is fast gaining popularity in that country.
Dr Hacking is a world pioneer in both PAE for men and Uterine Fibroid Embolisation (UFE), the treatment of fibroids in women.
“Over half of all middle-aged men suffer from prostate enlargement, which though non-cancerous can cause severe symptoms and embarrassment, while women with fibroids and adenomyosis can experience heavy menstrual blood loss, pain, pressure symptoms and even fertility problems,” said Dr Hacking.
“I’m passionate about being able to offer these non-invasive treatments that have minimal recovery time and such a high safety profile.”
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