Prof. Dr. Dr. med. Thomas J. Vogl is an internationally recognized specialist in radiology and is one of the leading experts in the field of diagnostic and interventional radiology. As Director of the Institute for Diagnostic and Interventional Radiology at Frankfurt University Hospital and Professor of Diagnostic Radiology at the Johann Wolfgang Goethe University, he has made a significant contribution to the further development of his specialist field.
Prof. Dr. Dr. Vogl is particularly well known for his pioneering work in interventional oncology and vascular radiology, with innovative procedures such as transarterial chemoperfusion (TACP), embolization (TACE) and thermal ablation of tumors using radiofrequency and microwave ablation. Prof. Dr. Dr. Vogl is a sought-after scientist and author of numerous specialist articles and standard works that set standards in radiology and radiotherapy worldwide. He has received numerous scientific awards and is a member of leading international specialist societies. He also contributes to the further development of his specialist field as a member of the advisory board for scientific publications.
With his tireless innovation and unwavering focus on improving patient care, Prof. Dr. Dr. Vogl has earned an outstanding reputation as a physician and scientist. His exceptional expertise and commitment to medical progress offer new hope and perspectives to patients worldwide. His exceptional expertise and dedication make Prof. Dr. Dr. Vogl one of the most respected physicians of his time.
The editors of the Leading Medicine Guide were able to talk to him about prostate artery embolization and prostate diagnostics and biopsy.
Prostate artery embolization (PAE) is an innovative treatment method for prostate enlargement that is particularly impressive due to its surprisingly simple idea: the targeted reduction of the blood supply. This causes the prostate tissue to shrink naturally, which can significantly alleviate typical symptoms such as the frequent urge to urinate and difficulty urinating - without the need for major surgery! But how exactly does this gentle procedure work? And what makes it so attractive for many patients? Modern prostate diagnostics, which provides deeper insights into the prostate through the use of various imaging techniques, can already tell us a lot about the condition of the prostate. If a malignant change is suspected, a prostate biopsy can provide more precise answers by analyzing small tissue samples in the laboratory.
Prostate artery embolization (PAE) is a minimally invasive procedure that often helps men with benign prostatic hyperplasia (BPH) when conventional treatments such as medication are not effective enough.
“Men who have problems with their prostate usually suffer from hypertrophy, the enlargement of the prostate due to cell growth. This manifests itself in the fact that they get up more often at night due to the urge to urinate, but also have the sudden feeling of having to empty their bladder during the day. This is a massive reduction in quality of life. I recently had a patient who had to get up six times during the night. Some patients also spend the whole day looking for the next opportunity to empty their bladder. Patients currently have three options. After a urological examination, they can be treated with medication, usually by taking tamsulosin, an alpha-1 receptor blocker, which relaxes the muscles in the prostate and can therefore improve the symptoms. However, this can lead to increased side effects such as dizziness, meaning that this therapy is only suitable to a limited extent. The second option is for the urologist to remove the prostate, which improves the symptoms. The disadvantage is that problems with incontinence and impotence can occur, which is why this method is not very popular with patients. This is because removing the prostate changes the vas deferens so that the man's ejaculation no longer goes out the front, but into the bladder. Prostate artery embolization has developed as a third option,” explains Prof. Dr. Vogl at the beginning of our conversation and goes on to explain this new procedure:
“This procedure was developed based on the experience of urologists during prostate surgery. If the patient started to bleed during the operation, the artery was closed with small beads, usually made of gelatine or other biocompatible materials, to stop the bleeding. And here it was noticed that the prostate shrinks relatively quickly and the patients have fewer problems. It was precisely this phenomenon that was then developed into a separate therapy that can be used to actively and significantly reduce the size of the prostate. This therapy is carried out after a urological examination using MRI navigation. If the MRI reveals a suspected tumor, an additional biopsy is performed, which is also MRI-guided, which is also a special feature here in Frankfurt am Main. This technique enables targeted and more precise sampling of conspicuous areas of the prostate, which is particularly advantageous for high-risk patients, as it avoids unnecessary punctures and minimizes false-negative results. As far as the accompanying radiation exposure is concerned, this is as high as a flight to Thailand and back. The way we use this therapy in Frankfurt is special. The patient comes to us in the morning on an empty stomach, the approx. one-hour procedure takes place on an outpatient basis, the patient rests with us for approx. 4-5 hours and then goes home.
A prostate biopsy is recommended in combination with multiparametric magnetic resonance imaging (mpMRI), especially if prostate cancer is suspected due to an elevated PSA value or abnormal rectal palpation findings, but a more targeted diagnosis is desired.
The PAE procedure is relatively gentle. The procedure begins with a small puncture, usually in the groin. A thin catheter is then used to introduce small particles into the arteries that supply the prostate. These tiny particles specifically block the blood vessels that supply the excess prostate tissue with blood, causing it to shrink and the gland to lose volume overall. The flow of urine improves and the unpleasant symptoms are alleviated. PAE is particularly suitable for men who either do not want surgical treatment or for whom major surgery would be too risky due to other health factors. It offers a promising alternative for alleviating symptoms without putting too much strain on the surrounding tissue.
According to studies, the success rate of prostate artery embolization (PAE) is around 75-90%, depending on the patient constellation and indication, in terms of alleviating symptoms of benign prostatic hyperplasia (BPH).
PAE can effectively reduce symptoms such as the frequent urge to urinate, nocturnal urination and incomplete bladder emptying and lead to a noticeable improvement in quality of life. As the procedure is minimally invasive and does not require general anesthesia, it is a gentle alternative to surgical procedures such as transurethral resection of the prostate (TURP) for many patients. A repeat PAE may be necessary in certain cases, especially if the initial treatment has not had the desired effect or the symptoms increase again after an initial improvement. “Similar to a prostate resection, the prostate may start to grow again after embolization after approx. 5-7 years. It is therefore important that patients adhere to the recommended dietary rules to keep the growth of the prostate in check. This can also be done prophylactically. Patients should also see a urologist regularly and an MRI should be performed if the PSA value (prostate-specific antigen) increases,” recommends Prof. Dr. Dr. Vogl.
A prostate-promoting diet is based on a balanced, nutrient-rich diet. Foods rich in lycopene, such as tomatoes, are recommended as they can reduce the risk of prostate cancer. Saturated fats from red meat should be reduced and replaced with healthy fats from fish and nuts. Whole grain products and fiber-rich foods support digestion, while fruits and vegetables provide important antioxidants. Soy products and green tea may also have a protective effect on the prostate. Dairy products should be consumed in moderation, as high consumption is associated with an increased risk of prostate cancer. Sugar and processed meat should be avoided to reduce inflammation and promote prostate health.
“There are currently three large centers in Germany, in Hamburg, Jena and here in Frankfurt, which have experience with prostate artery embolization. It is important that the doctor performing the procedure has a lot of experience, as you are dealing with very small vessels and the beads have to be placed in the right place. I have personally performed over 1000 procedures. I also think that this method will be offered more widely in the future, but probably only if the health insurance companies play along better. It would be desirable, as the procedure is much less risky than an operation and does not require hospitalization. Of course, the operation has one advantage for the patient - it has an immediate effect. After embolization, the first noticeable improvements occur after about 3-4 weeks, and the real effect is achieved after about three months. The patient also has to do more themselves, for example in the form of pelvic floor training,” says Prof. Dr. Dr. Vogl.
PSA value (prostate-specific antigen)
The PSA value is a protein that is produced by the prostate and is measured in the blood. It is primarily used to test for prostate cancer and to monitor prostate diseases. An elevated PSA level can indicate prostate cancer, benign enlargement of the prostate (BPH) or prostatitis (inflammation). A PSA value below 4 ng/ml is often considered normal, but the value varies depending on age and individual factors. Further tests are required if the PSA value is elevated.
The choice of treatment method increasingly depends not only on medical aspects such as the size and location of the prostate, but also on the patient's individual needs and expectations regarding their everyday life and the expected quality of life after the procedure.
Compared to surgical procedures such as transurethral resection of the prostate (TURP) and open prostatectomy, PAE offers a minimally invasive alternative that generally involves shorter recovery times and a lower risk of serious complications. This is particularly appealing to patients who are worried about potential side effects such as urinary incontinence or erectile dysfunction, which can occur more frequently with surgical procedures, and at the same time want to return to their normal everyday life as quickly as possible.
“Prostate artery embolization can be used for all age groups. My oldest patient was 94 years old! With younger patients, you also have to check whether there is another problem. In any case, good cooperation with colleagues from the urology department is important, which I really appreciate here in Frankfurt. The method is very good in the hands of experienced doctors, and of the 1000 patients we have treated with it, 900 are 100% satisfied,” explains Prof. Dr. Dr. Vogl, and with that we end our conversation.
Thank you very much, Professor Dr. Dr. Vogl - that was a very interesting insight into the options for prostate treatments!
