A RETIRED businessman has hailed the "life-changing" effects of a pioneering new treatment for enlarged prostate after becoming one of the first patients from Scotland to undergo the operation.
Allan Burns, 71, had been plagued by pain, infections and sleep disturbance since 2016 after developing an enlarged prostate, a condition that affects around half of men over 50 at some point in their lives.
Symptoms also include a frequent need to urinate which means waking up several times a night, and risk of 'leakage'.
Mr Burns, a grandfather and former executive director and global procurement director for drinks giant, Diageo, was prescribed pills by his GP and tried cutting out alcohol, tea and coffee to limit the effects. But by 2017, he said the condition was taking an increasing toll on him physically and emotionally.
He said: "In 2017, it was my wife's 70th birthday and we decided to do a cruise. It meant a long-haul flight across the Atlantic and I made the mistake of indulging in a coffee and a glass of champagne before the flight, and I must have wore the carpet out getting up and down to the toilet on the flight. I was up and down to that toilet every 20 minutes, and then I had a bad experience of leakage when I was coming back through an airport.
"I was getting up five times a night. I play golf and I could not turn onto my right side at all. I had lots of pain, I think partly due to infections.
"If you're going on a long drive somewhere - even just down to Edinburgh - you plot where you can go to the toilet along the route, and when you can go.
"But if you all of a sudden realise you need to go to the toilet and you're in public, you've got a real problem on your hands. You don't have time.
"So it was really eating away at my confidence as well as my physical functions. It really impacts virtually every part of your life."
At the time Mr Burns, who lives in Kincaple, near St Andrews in Fife, was also the chair of NHS Fife. As a result, he had access to medical journals and happened upon an article on Prostate Artery Embolisation (PAE).
The procedure had been developed originally in Portugal and Brazil as an alternative to invasive surgeries. Most patients treated on the NHS at present undergo Trans-urethral resection of the prostate (TURP), a procedure where the enlarged prostate is "scraped" down to size in a technique similar to peeling a potato. However, this carries a risk of loss of fertility, sexual pleasure and impotence, as well as a two-night hospital stay and blood loss - in some cases enough to require a transfusion.
In contrast, PAE - which costs around £2000 - is performed as a day-case operation under local anaesthetic. The surgeon punctures an artery in the wrist or groin and inserts an extremely narrow plastic tube from there into the arteries supplying blood to the prostate and then injects tiny plastic particles, roughly the size of fine grains of sand, to significantly curtail but not cut off the blood supply.
This leads the prostate - which is normally the size of a walnut, but can swell to the size of a tomato in patients worst affected - to shrink, restoring the bladder to normal function.
In 2018, it was approved for use on the NHS by the National Institute of Clinical Excellence (NICE) following a year-long trial involving 305 patients across 17 UK centres, including Glasgow. Unlike medicines, NICE guidance on interventional procedures apply in Scotland, as well as England and Wales.
However, a shortage of trained and experienced clinicians and NHS funding means PAE is only available on a very limited basis at some hospitals in England, and none elsewhere in the UK. In most cases, patients are paying to go private.
Mr Burns, who has private health insurance, is one of only five men from Scotland to date who have undergone the procedure at the Spire Healthcare hospital in Southampton, where the surgery is performed by Dr Nigel Hacking. Dr Hacking, an interventional radiologist who is now retired from the NHS, led the UK-wide PAE study.
The operation was performed on October 12 2018, and within three weeks Mr Burns said his symptoms had all but vanished.
"I wasn't up at all during the night," he said. "I don't plot round the golf course where all the toilets and bushes are. I can drive anywhere, and when you're in the car in traffic and you think 'I must go to the toilet', you can wait.
"It's made me feel much more confident, and it's been a life-changing thing for me emotionally. I'm back to being able to do the things I want to be able to do."
Dr Hacking estimates that adopting the procedure instead of TURP would save the NHS an average of £800-900 per patient by avoiding inpatient stays, and he is currently working with NICE to prove the financial benefits to the health service.
In the meantime, men who can afford it and are put off by the potential side effects of TURP are footing the bill themselves.
"Even centres like Bristol, Exeter, Derby and Leicester that have been trained in PAE are struggling to get the business cases through, which is extremely frustrating, said Dr Hacking. "It will be adopted by NHS units north and south but the short answer is we don't have the money right now.
"The advantage of PAE is that it's a day case procedure. There's no blood loss. There's no loss of sexual function. I wouldn't want to over-exaggerate the risk of impotence after TURP, but there's a small chance.
"So understandably men in their 50s and 60s that want to keep sexual function and fertility and pleasure, would like to try something other than TURP."
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