Prostate Cancer- New Treatment - Questions and Answers

What is Chemoembolization?

The embolization of the hypogastric arteries has been attempted and described to treat conditions secondary to uncontrollable bleeding, prostatic or bladder oncological conditions or surgery. We ourselves have published in 1989 in the American journal “Radiology” its achievement in uncontrollable bleeding of the pelvis due to tumors. The supraselective arterial embolization for the treatment of urinary symptoms secondary to BPH was the technique used in a patient with persistent hematuria, described by DeMeritt in 2000. The embolization of prostatic arteries (EAP) in the Treatment of Benign Hyperplasia is an innovative technique, minimally invasive and reliefs symptoms. It is held at the St. Louis Hospital. It has a lower risk than surgery and good preliminary results. Its purpose is to interrupt the blood flow that supplies the prostate, solving the problem and preserving the prostate. No blood flow to the prostate causes its atrophy and symptoms improve or disappear.

The team of the Hospital Saint Louis Interventional Radiology, after making successful embolization in over eight hundred patients with uterine fibroids, is now performing embolization in benign prostatic hyperplasia. In our country, it is held at the Hospital Saint Louis, since March 2009 and over 1400 patients have already been treated.

Anywhere in the world, the embolization is carried out by an Interventional radiologist, a doctor who is specially trained to carry out this and other types of minimally invasive techniques, without any incision and leaving no scar. Chemoembolization is embolization of prostate arteries with cytostatics and particles performed for patients with prostate cancer.


How is Chemoembolization performed?

Under local anesthesia, and without loss of blood, a small hole of 1.5 mm diameter in the groin is made, through which a thin plastic tube, catheter, is introduced. By a sophisticated digital X-ray monitoring apparatus, the catheter is led into the prostatic arteries in which citostatic, plus embolizing small particles are then injected in the prostate arteries, closing the branches that supply this gland, but saving the internal pudendal artery, so that the patient can still keep erectile function.

Embolization is then repeated on the opposite prostatic artery, through the same hole and through the same catheter.

The technique usually lasts about 1 hour, while the patient is conscious and may even display the television monitor that shows the treatment in vivo. After the procedure, manual compression is carried out for about 10 minutes and a small compressive dressing is placed and maintained until the next morning. Two hours after embolization, the patient should be able to get up and urinate.

Hospitalization only lasts a few hours and almost all patients go home after dinner, if the blood pressure is normal even if they live several hundred kilometers away from Lisbon. In this period, there will be a permanent contact with the medical team to assess complains or clarify any doubts.

How did the embolization start?

For years, I thought about the embolization as a treatment of benign prostatic hyperplasia.

In March 2009 I was contacted by a friend of 78 years with benign prostatic hyperplasia, bladder catheter for 6 months, and major depression. He refused surgery, as he had suffered a lot the three times he had submitted to it. After exclusion of malignancy and explanation of the technique and risks, he was treated successfully, with withdrawal four days later. He began to urinate without any difficulty, got out of depression and his sexual activity improved considerably. Six months later his girl friend was pregnant.

Given the success of this technique the absence of complications and the high incidence of prostate cancer, I began performing chemoembolization in patients refusing surgery or other alternative treatment on April 2013.


What tests need to be runned before chemoembolization?

Besides the prostate biopsy that you have done, you need to make a pelvic ultrasound via rectum to evaluate the prostate volume. The patient must also have PSA, flowmetry, post-voiding bladder residue and routine blood tests (blood count, cholesterol, triglycerides, creatinine, urea and total and free testosterone). Finall, you will have to perform a CT angiography to study the pelvic vessels. If the PSA is higher than 10 you need to do a bone scintigraphy. Finally you need to do a parametric Resonance Magnetic of the prostate.

What are the risks associated with Chemoembolization?

Embolization is a very safe technique, however, it may be associated with some risks, as any medical treatment, but they are rare. Currently, most patients do not feel any symptoms after embolization. Some may refer slight pain, heat or burning, which are easily controlled by appropriate medication. The embolization risks are much lower than surgery. In order to avoid risks, patients whose arteries are very atherosclerotic, revealed by the Angio TAC, are excluded. Complications are those of any catheterization, being the most frequent, the hematoma at the puncture site, urinary tract infection; easily prevented by taking antibiotics started before embolization), urine or sperm with blood and temporary purple colouring of the thigh and abdomen. However, these side effects disappear after a few days without treatment.


Will Chemoembolization be painfull?

Embolization does not cause any pain during or after the procedure.


How long does it take to recover from it?

The day after embolization, the patient should not stay in bed and can, in most cases, get back to his normal life. However, the patient shall not drive. The patient can resume his professional activity usually 2 days after treatment.


 How are the results of chemoembolization evaluated?

There will be a great reduction of the PSA and prostatic ultrasound carried, a reduction in prostate volume of about 10% to 30% can be observed, disappearance of symptoms take place soon after embolization or at the latest after one week week. The parametric Resonance Magnetic will show no increase in size of the tumor, reduction in size or the tumor may not be shown.


Is my sexual potency affected?

Unlikely prostatectomy and TURP, in which some patients are left with sexual dysfunction, retrograde ejaculation, sexual function is not affected after chemoembolization.

None of the 1400 treated patients for BPH, had sexual function affected.

Can I be treated by Chemoembolization?

You can be treated only if you refuse any other treatment for prostate cancer and if your prostatic arteries are not involved by advanced atherosclerosis.


What to do to be treated?

If you live in Portugal must ask for an appointment at the Hospital Saint Louis. You should do prostate ultrasound with rectal probe, ultrasound of bladder, PSA, recent urinary flow rate  and residue vesical post-micturition.

Before the appointment you must complete international surveys on symptoms, quality of life and sexual function.

The doctor will examine your case and the technique will be explained to you. It may be necessary to run more tests. After this consultation, you must do an Angio CT for evaluation of the pelvic vessels and possible treatment. However, this test has some limitations because some aspects of the vessel’s anatomy cannot be detected by CT and only during treatment. If you live abroad you need do the reconditions written before in ≠ 8.

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