In 2003, Dennis McDougal retired after a long and successful career in the railroad industry. He and his wife Candace remained in Denver, where they had happily settled in 1997.
About the time of his retirement, however, McDougal, now 74, noticed that when he walked, his right arm didn’t swing naturally and in rhythm with his left one. After seeing more than one neurologist, he was eventually diagnosed with Parkinson’s disease. He continues to receive care for the movement disorder at the UCHealth Neurosciences Center – Anschutz Medical Campus.
But another problem common to older men severely complicated McDougal’s health and quality of life: benign prostatic hyperplasia (BPH), or non-cancerous enlargement of the walnut-shaped prostate gland, which sits below the bladder. When the prostate enlarges, it restricts the flow of urine from the bladder to the urethra, the tube through which urine passes out of the body. BPH can make a man have to get up frequently to urinate and with greater difficulty. In severe cases, the blockage causes urinary tract infections. Some patients may have to wear catheters to drain the bladder – in itself an infection risk.
Parkinson’s disease complicated by enlarged prostate
For Dennis McDougal, BPH was a particularly tough problem because his Parkinson’s disease causes tremors and gait and balance problems. He had to get up several times a night to go to the bathroom, which increased his risk of falling and made it very difficult to go anywhere outside his home. He became, in effect, a prisoner to the BPH.
Urologists can treat BPH by surgically entering the urethra and reducing the size of the prostate with heating, freezing, coring and other techniques, said Dr. George Zlotchenko, medical director of Radiology and Interventional Radiology at UCHealth Highlands Ranch Hospital. McDougal needed treatment of his enlarged prostate, Zlotchenko said, but was looking for a minimally invasive alternative to surgery because of his Parkinson’s disease symptoms, particularly tremors.
A non-surgical treatment for enlarged prostate
Urologist Dr. David Sobel at Highlands Ranch Hospital referred McDougal to Zlotchenko, who offered McDougal a minimally invasive treatment option to consider: prostatic artery embolization (PAE). Surgery pares the enlarged prostate down to size; embolization shrinks it by starving its blood supply. The provider uses a catheter to deliver microscopic particles to the blood vessels that feed the prostate. The particles obstruct, or embolize, blood flow to the enlarged gland, and it gets smaller. It’s an outpatient procedure that is almost completely painless and generally allows patients to go home the same day, Zlotchenko said.
It’s a tested approach. Interventional radiologists use embolization to shrink non-cancerous uterine fibroid tumors the same way they shrink enlarged prostates. Blood flow-blocking particles are also used in genicular artery embolization to treat knee pain caused by osteoarthritis, but in that case, the goal is to reduce inflammation rather than shrink tissue.
To qualify for PAE, patients complete an International Prostate Symptom Score (I-PSS) questionnaire that measures the severity of their issues, such as frequency and urgency of urination, as well as the effects of the condition on their quality of life. The higher the score, the greater the symptom severity and likelihood that a patient is a candidate for the procedure, Zlotchenko said.
Preparation before pursuing prostate artery embolization
Prior to PAE, Zlotchenko said he performs a CT angiogram to examine the blood vessels for potential challenges, like plaque-stiffened arteries. With the patient anesthetized, he threads a catheter, generally through the radial artery in the wrist, and advances it to the prostatic artery, guided by contrast and 3D imaging. With the catheter properly positioned, he deploys the blood flow-blocking particles. The greatest risk, Zlotchenko said, is “non-target embolization,” meaning deploying the particles to the wrong area, such as the bladder or rectum, but he added it’s a relatively rare problem that he’s never encountered in the PAEs that he’s performed.
Zlotchenko said he’s had “excellent results” from PAE, as measured by comparing patients’ pre-procedure I-PSS scores to their results three months after. He added that it’s possible to repeat the procedure, but so far he hasn’t had to.
“The data show it has had pretty durable results,” Zlotchenko said.
He emphasized that PAE can be a primary treatment for BPH as well as an alternative to surgery or medical therapy. He’s part of a treatment team, he added. “I always send patients to a urologist to consult before they make a decision,” he said.
Not all urinary symptoms are caused by prostate problems, Zlotchenko noted, which also emphasizes the importance of working with a urologist. For example, sometimes problems in the brain, the spine or nerves disrupt control of the bladder. The condition, called neurogenic bladder, can cause urinary problems similar to BPH.
Improved quality of life after successful prostate artery embolization procedure
Zlotchenko carefully explained the details of the PAE procedure to the McDougals and gave them literature to review. “He went into great depth,” said Dennis, who decided on PAE and its minimally invasive approach. He had it at UCHealth University of Colorado Hospital on the Anschutz Medical Campus in September 2021.
McDougal’s Parkinson’s disease made his case unusual, and Zlotchenko and his team took extra precautions to address it. For example, McDougal’s tremors had to be well-controlled before Zlotchenko could painstakingly guide the catheter through his blood vessels.
The strategy included putting McDougal under general anesthesia “to keep him paralyzed,” Zlotchenko said. In addition, “I worked with my anesthesia colleagues to make sure the patient got his medications as close to his scheduled doses as possible.”
The procedure went well and has helped improve McDougal’s symptoms. He keeps a bedside commode as a precaution but is no longer making multiple and often unproductive trips to the bathroom every night. With that, his fall risk has decreased, which is especially important as his Parkinson’s disease continues to progress.
He also has a new measure of stability in his daily life. Before the procedure, the problems caused by his enlarged prostate meant that it was nearly impossible for him to go anywhere that he didn’t have constant bathroom access.
“It’s given us a much better quality of life, even enabling us to take short walks together,” Candace said.
Dennis too appreciates the improvements Zlotchenko made possible with PAE. “It has made a world of difference for the good,” he said.
To reach Dr. Zlotchenko at the TCU Medicine Interventional Radiology – Highlands Ranch Specialty Care Center, call 720.516.3064.