Enlarged prostate

Dr Marios Agathangelou performs prostatic artery embolization (PAE) in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Prostatic artery embolization treats benign prostatic hyperplasia (BPH) from inside the vessels: through a catheter placed via a 1–2 mm incision, calibrated microspheres block the arteries feeding the prostate on both sides.

Starved of blood, the gland shrinks over the following weeks and urinary flow improves in most patients — an established alternative to TURP that aims to preserve sexual and urinary function, with a typically lower risk of complications than surgery.

No surgical incision Aims to ease urinary symptoms Aims to preserve sexual function Same-day or overnight Alternative to TURP

The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.

Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.

The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.

Both need a valid referral, from your personal doctor or from a specialist.

Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.

An enlarged prostate is judged by what it causes you, not by its size: a weak stream, difficulty starting, the sense that the bladder has not emptied, waking at night to pass urine, sudden urgency. If it wakes you at night and organises your day around where the toilets are, that is the measure — not the size.

An enlarged prostate is not an emergency. Symptoms rise and fall; in some men they stay much the same for years, and in some they ease on their own.

What does not resolve on its own is the obstruction. The bladder works harder against it, and over the years it can thicken and lose some of its power.

In practice that means waking more often at night and a weaker stream — and, at the far end of the range, sudden inability to pass urine, repeated infections, stones in the bladder, or a bladder that never quite empties.

How often does it get that far? Rarely. In a community study of 2,115 men followed for four years, sudden retention happened to about 7 men in 1,000 each year.

The odds are not the same for every man. For men in their seventies with troublesome symptoms it was closer to 35 in 1,000 a year — about 1 man in 29 — and for men the same age with few symptoms, 9 in 1,000. A weak stream and the degree of enlargement both raise it, and both are measured at the assessment.

The kidneys sit at the far end of that range, and rarely: a bladder that never empties can affect them, though how often that happens is not well established.

Nothing about this has to move quickly. Ask whatever you want, as often as you want; we will be here whenever you decide.

Embolization treats obstruction caused by the prostate. If the symptoms come from an overactive bladder, a neurogenic bladder or a narrowing of the urethra, the prostate is not the problem and embolization will not solve it. Bladder stones or chronic retention needing surgery, heavy atherosclerosis of the arteries, and impaired kidney function are also reasons not to proceed. This is why assessment is done together with a urologist, not instead of one.

It is the question most men do not ask, and it is one of the main reasons this treatment exists. Retrograde ejaculation is common after transurethral resection (TURP); after embolization it is reported far less often. Erectile function is not made worse by embolization — in the studies it stays the same or improves in most men. If this matters to you, say so; it is a legitimate basis for choosing.

Symptoms improve substantially for most men, and embolization carries roughly half the adverse events of TURP over the first year.

And the other side, because it matters to the decision: TURP gives a greater average improvement in symptoms, and after embolization more men need a second procedure within the first year. The benefit also fades gradually over the years. The choice is a real trade-off, not a one-way street.

Most men have no trouble at all. Pelvic discomfort, a low fever and burning when passing urine are common in the first days and settle on their own.

The serious risk worth knowing about is the treatment reaching the wrong artery. It is rare. In a UK national registry of 216 men it happened twice, and in both it showed as a small ulcer on the skin of the penis that healed on its own.

The risk is not the same for everyone. The arteries of the bladder, the rectum and the penis run close to the prostate’s own, and hardened or unusually arranged vessels make the work harder. They are mapped before anything is injected, and in some cases that changes the plan. Kidney function is checked beforehand, because the procedure uses X-ray contrast.

Less often, and less seriously: a bruise where the catheter went in, a small tear in an artery wall, and rarely an infection. In that same registry, of the 216 men, one had sepsis and one needed a transfusion.

Occasionally the prostate’s arteries cannot be reached, and the procedure is stopped rather than forced. That is not a complication, and nothing has been lost — the surgical route remains open.

The most important difference from surgery is not a complication — it is repetition. In that registry one man in twenty needed a second procedure within the year, and one in five over the whole follow-up: more than after TURP. It is not a dead end — embolization can be repeated, and surgery remains open afterwards.

One thing it does not do: it removes no tissue for examination, and it is not a treatment for prostate cancer — your PSA checks and your urologist’s follow-up go on as before.

You are seen again at one, three, six and twelve months. The prostate keeps shrinking through that first year, so those visits are there to confirm it on imaging, to check that the symptoms are easing — and to see early if they are not.

We will go through all of it before you decide.

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