Enlarged Prostate: The Silent Threat Men Should Not Overlook

Benign Prostatic Hyperplasia (BPH) is a condition where the cells of the prostate gland increase in number more than usual, causing the prostate to enlarge. This enlargement may compress the urethra passing through the center of the prostate, leading to urinary problems. BPH is a non-cancerous condition commonly found in men over 45 years old and tends to increase with age. Among men aged 70 and above, the prevalence can be as high as 80%.

Symptoms or Warning Signs of Enlarged Prostate

Enlarged prostate can be observed through symptoms occurring in the urinary system as follows:

Frequent urination, especially at night, causing frequent trips to the bathroom and disturbing sleep.
Difficulty urinating, such as interrupted flow, weak stream, needing to strain or urinate repeatedly, and feeling pain or discomfort during urination.
Difficulty controlling urination, including incontinence or sudden urgent need to urinate.

Acute urinary retention may occur in some cases, which is an emergency requiring immediate treatment.

These symptoms not only cause discomfort but also lead to stress and anxiety. If left untreated, complications such as urinary tract infections, urinary retention, or long-term kidney disease may develop.

Treatment of Enlarged Prostate: Various Treatment Options

Treatment for enlarged prostate ranges from lifestyle adjustments, medication, surgery, to new technologies that improve treatment outcomes. The treatment options can be divided into four main approaches, starting with:

Lifestyle adjustments if symptoms are mild and manageable by changing habits, such as avoiding tea, coffee, and alcohol to reduce frequent urination, and limiting fluid intake in the evening or before bedtime to reduce nighttime bathroom visits.
Medication is another effective option, mainly involving two groups of drugs: Alpha Blockers, which relax the smooth muscles around the prostate and bladder neck to ease urination and reduce difficulty; and 5-Alpha Reductase Inhibitors, which reduce prostate size by inhibiting the conversion of certain male hormones, causing the prostate to shrink gradually, relieving pressure on the urethra and effectively alleviating symptoms. In some cases, doctors may prescribe both groups to enhance treatment effectiveness and reduce the risk of complications such as acute urinary retention.
Traditional surgical treatments
- Transurethral Resection of the Prostate (TURP) involves inserting special instruments through the urethra to scrape or cut away the enlarged prostate tissue. This is suitable for patients with moderate to large prostate enlargement.
- Transurethral Incision of the Prostate (TUIP) creates small cuts to widen the urethra, suitable for small to moderate prostate enlargement.
- Holmium Laser Enucleation of the Prostate (HoLEP) is suitable for large prostate glands.
New technology treatments

Water Vapor Therapy uses steam at about 103 degrees Celsius injected to destroy prostate tissue compressing the urethra, causing tissue shrinkage and widening the urinary passage. Suitable for small to moderate prostate enlargement.
Laser Ablation helps reduce urinary tract obstruction.
Prostatic Artery Embolization (PAE) is a new treatment option that blocks small arteries supplying the prostate, causing the tissue to shrink naturally and relieving symptoms without surgery.

PAE: A Non-Surgical Treatment Procedure for Enlarged Prostate

Prostatic Artery Embolization (PAE) is a minimally invasive treatment that blocks the arteries supplying blood to the prostate, causing the prostate tissue to shrink. It is a precise and low-risk procedure suitable for patients who cannot undergo surgery or have high anesthesia risks. The procedure includes the following steps:

The doctor inserts a small catheter through an artery in the groin or wrist, usually preferring the wrist for better catheter control.
The catheter is advanced to the major pelvic artery, the entry point to the arteries supplying the prostate. Local anesthesia is used without general anesthesia.
The doctor injects contrast dye and uses Digital Subtracted Angiography (DSA) and Cone-Beam CT imaging to clearly visualize the pelvic blood vessels and accurately identify the prostatic artery.
Once the prostatic artery is located, the doctor carefully advances a microcatheter through the blood vessels to the target site on each side, as the vessels are small and complex.
Small embolic particles (microspheres) are slowly injected to block the arteries supplying the prostate thoroughly.
After embolizing one side, the doctor takes repeat X-rays to confirm complete blockage and no non-target embolization, then repeats the procedure on the other side for comprehensive treatment.
After completing embolization on both sides, the catheter is removed, bleeding is stopped, and the patient is monitored for initial complications before being discharged the same day.

After PAE, patients may experience urinary discomfort, frequent urination, and burning sensation for about 3-7 days due to the body’s response to artery blockage. These symptoms gradually improve and disappear. Symptoms of enlarged prostate, such as nighttime urination frequency, begin to improve within 3-4 weeks, with clearer results continuing up to 3-6 months. The treatment effect is usually permanent.

Who is Suitable for PAE Treatment?

PAE is an option for those seeking non-surgical treatment for enlarged prostate. Suitable candidates include:

Those with moderate to severe symptoms such as frequent urination, incontinence, interrupted flow, or feeling incomplete emptying, affecting quality of life.
Those who have limitations or are unsuitable for surgery, such as elderly patients, those with chronic diseases, heart conditions, or those on blood thinners who cannot stop medication.
Those with large prostate size (over 40 grams).
Those who want treatment that does not affect sexual function, which is less common with traditional surgery.
Those experiencing side effects from prostate medications, such as dizziness from low blood pressure, erectile dysfunction, or retrograde ejaculation, and want to reduce or stop medication.

Advantages of PAE Compared to Prostate Surgery

It is a non-surgical procedure without general anesthesia, reducing anesthesia risks in elderly patients.
The procedure takes about 2 hours on average, with a short hospital observation period, allowing discharge the same or next day.
No need for urinary catheterization before or after treatment, resulting in shorter home recovery time and quicker return to normal activities.
No surgical instruments inserted through the urethra; the only wound is a needle-sized puncture on the wrist or groin.
Fewer side effects compared to traditional surgical techniques.
Does not affect sexual function in most patients.

Possible Side Effects or Complications of PAE

PAE is a highly safe and low-risk procedure when performed by specialists, but side effects and complications may occur, including:

Pain in the pelvic area, frequent or painful urination, low-grade fever, fatigue, usually occurring within 1-4 days and improving within 3-7 days.
Minor bleeding or bruising at the artery puncture site (wrist or groin), common but not severe.
Urinary tract infection, especially in patients with urinary catheters, which can be prevented by antibiotics before and after treatment.
Blood in urine, semen, or stool, occurring in some cases but temporary and usually resolving within 1-2 weeks.
Risk of urinary obstruction from prostate tissue debris after the procedure, occurring in about 1-2% of cases.

Self-Care After PAE

Get enough rest and avoid heavy activities or exercise for the first 1-2 weeks.
Drink plenty of water to help flush out contrast dye and reduce the risk of urinary tract infection.
Take pain medication as prescribed by the doctor.
Monitor for abnormal symptoms such as high fever, severe painful or difficult urination, heavy bleeding, or redness and swelling at the puncture site. Seek medical attention immediately if these occur.

If you experience frequent urination, incomplete emptying, or interrupted flow, these may be signs of an enlarged prostate. Phyathai Phaholyothin Hospital has a specialized urology team ready to provide consultation, care from diagnosis to treatment options tailored to each patient, including medication, surgery, and innovative PAE treatment, which offers increased safety and effective results for those unsuitable for surgery.

Do not let these symptoms diminish your quality of life. Early detection and treatment are the keys to regaining confidence and living life fully again.

Dr. Anawat Siwaleepan
Interventional Radiologist
Phyathai Phaholyothin Hospital

In-depth treatment of benign prostatic hyperplasia without surgery using the PAE technique