Recently, as far as we can tell, a Queensland man was the first to receive an innovative procedure for an enlarged prostate. The same technique has been used for fibroids in the uterus as well. But it isn't well known.

Dr Roger Livsey is an interventional radiologist at the Mater in Brisbane and he's one of the pioneers.

Roger Livsey: There's a new procedure which has been developed in Europe to treat benign prostate hyperplasia, the very common condition of men of middle age. The technique is simply to get into the arteries feeding the prostate, fill them full of tiny particles, and this blocks the arteries and causes the gland to shrink whilst retaining continence and retaining the ability to ejaculate, which the normal treatments don't maintain.

Norman Swan: They don't maintain? How come?

Roger Livsey: The normal treatment for benign prostate hypertrophy is the transurethral resection, which is scraping out the gland from inside, and that takes away the sphincter, the seal of the top of the gland which when a man ejaculates it stops the sperm going up and makes it go down…

Norman Swan: So it's like a valve, so you lose the valve, so it only goes back.

Roger Livsey: It only goes back, that's right.

Norman Swan: How do you find the artery in the prostate?

Roger Livsey: That's a trade secret! But in fact it's not that hard and we are well practised in it from other procedures. You feed small catheters into little tiny tubes…

Norman Swan: What, from the thigh, from the femoral artery or where?

Roger Livsey: Well, people doing a lot of them tend to use the arm because going from the arm gives you a very straight line, you haven't got to do big curves and bends. You inject dye, when you think you are in the right place you do a CAT scan at the same time and you can see where the dye is and you know you're in the right place.

Norman Swan: Okay, so you stick in a catheter in the radial artery in the hand and you feed it down through the aorta, down towards the pelvis where the thing is, and by some magic you find your way to this tiny little artery that supplies the prostate.

Roger Livsey: Yes, that's the one, the brachial artery commonly at the moment, just in the bend of the elbow.

Norman Swan: So just take me through the risks of this procedure.

Roger Livsey: The actual technical risks of getting in and getting to the thing are very low, and the actual procedure, there's a surprising number of them have been done now, hundreds…

Norman Swan: But not in Australia.

Roger Livsey: Not in Australia, no. You can cause ulceration. If you put the particles in the wrong place they will block blood supply to the wrong areas and you can get ulcers in the bowel, ulcers in the bladder. There have been cases where people have needed surgery to correct these problems, but so far as I know nobody has done anything too terrible with it apart from that.

Norman Swan: So the radiologist has got to be pretty sure they are in the right artery.

Roger Livsey: Yes. You know the technique, you know where the arteries are, you put dye in to see where they are feeding and then you put dye in to do the little CAT scan to see what's actually being fed, and you know where you are.

Norman Swan: So before you put any particles in you make sure that what you are injecting is going into the prostate itself.

Roger Livsey: Yes, that's right.

Norman Swan: So these are little particles, what, just little plastic bubbles or something, what are they?

Roger Livsey: Basically they are inert material and they just act as a mechanical block. There's various brands and sorts of them but they are essentially tiny, tiny particles of plastic, half a millimetre.

Norman Swan: So you are essentially causing a prostate attack.

Roger Livsey: Yes, yes, we infarct it, it dies, the inside of it dies.

Norman Swan: What happens to it all?

Roger Livsey: Somehow the body mops it up afterwards, it shrinks, the cells once they are dead they lose their water, they shrink, and then blood supply around it cleans things up, and the phagocytes, the cells in the blood take all the bits and pieces away and it all cleans up.

Norman Swan: And does it destroy the whole prostate? One of the issues of benign prostate enlargement is men have different sizes of prostate, so you can have a really large prostate. How much tissue do you actually lose and is it enough to get rid of the man's urinary symptoms?

Roger Livsey: Well, the evidence from overseas is that yes, when you embolise the centre of it you are embolising the gland tissue, not the capsule, not the thick sheath around it, and you embolise the lot and it all shrinks down.

Norman Swan: Magic. Are there any side-effects, apart from the complications you just mentioned?

Roger Livsey: I don't think so, no. It basically produces a shrunken gland and restores urine flow and leaves one's sexual function as it was.

Norman Swan: So the man walks out, gets in the car and goes home.

Roger Livsey: No, they'll keep a catheter in for a few days.

Norman Swan: So they are catheterised and then you follow them up. So the first one was done by your colleague, and you've been doing ones for fibroids for a long time, the same procedure. Explain what a fibroid is first of all.

Roger Livsey: Ladies get them, it's a benign growth on the uterus, they are very common. Some populations have 50% to 70% ladies have at least one small one. They can get very big, they can cause terrible bleeding, menorrhagia. They can cause trouble just by their mass. And if they are in the right place, they can cause a lot of trouble getting pregnant in younger ladies. But they are benign.

Norman Swan: And what has been the treatment before embolisation came along?

Roger Livsey: There are various treatments. The most drastic one is hysterectomy, but short of that you've got myomectomy, which is cutting out the fibroid and the associated piece of uterus and sewing the uterus together again. And there's hormone treatments. And if they are inside the uterus, if they are up against the uterine lining there's a resectoscope, you can go inside and scrape them out.

Norman Swan: So how successful is embolisation for fibroids?

Roger Livsey: Extremely. We've been doing it for about 15 years now. We've only done a couple of hundred of them but there's many tens of thousands done internationally. And very few side-effects.

Norman Swan: So tell me about cost here.

Roger Livsey: I do them for nothing at the Mater public hospital, I just ignore the cost of it.

Norman Swan: How typical of a doctor in the public system. But seriously, if this has got legs, and I'm always hesitant talking about new technologies on the Health Report because things go wrong and there are commercial interests and what have you. But it's not going to fly if it's going to cost a fortune.

Roger Livsey: Oh, it doesn't cost a fortune, it costs less than a hysterectomy.

Norman Swan: And the prostate embolisation?

Roger Livsey: It shouldn't cost a lot either. The particles can be a few hundred bucks at the moment. The companies make a lot of money out of these particles, and the catheters and all the rest, but the actual consumables aren't too bad.

Norman Swan: And I should get just a declaration of interest; you don't take any money from these companies?

Roger Livsey: No.

Norman Swan: Ophthalmologists say if a new procedure comes along for cataracts it takes them 25 eyes to get good at it. How many prostates or fibroids do you have to do before you're good at it?

Roger Livsey: We didn't have any problems early on. We took longer to do it and there was more fiddling around with equipment and discovering what worked and what didn't work.

Norman Swan: So this is a wee bit disruptive, isn't it? You are presumably peeing off the gynaecologists because you are taking away their business with fibroids in the uterus, and now the urologists are being done out of a job because you are embolising the prostate.

Roger Livsey: The gynaecologists at the Mater now are on side, it's good. I will say that some of the patients who come for the fibroid embolisation are somewhat unhappy because they've had consultations which have led to the recommendation of a hysterectomy and had to find out about this themselves.

Norman Swan: How often do you have to repeat the procedure with fibroids to do the job?

Roger Livsey: We haven't for years.

Norman Swan: And Roger, do you know if it's happening elsewhere in Australia or is Brisbane, as always, leading the way?

Roger Livsey: There's some being done down south, I don't know how many. Elsewhere in Brisbane there is occasional ones being done, but the referral isn't there, people don't get referred, and it's just too hard. The thing about the prostate is I'm sure once the power group of men knows that there is this treatment out of there which will leave them able to have sex properly still, then there will be some demand for the procedure.

Norman Swan: But you've got to get referred.

Roger Livsey is an interventional radiologist at the Mater in Brisbane.