Less risk, more reward: Enlarged prostate procedure preserves sexual function

In 2017, Kenneth Outlaw’s life was plagued by constant interruptions. He couldn’t sit through a movie and was frequently getting up in the middle of the night.

Why? He had benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland, which is usually walnut-sized and rests below a man’s bladder. It surrounds the urethra, the tube through which urine travels from the bladder out of the body, and its primary function is to produce a nutrient-rich fluid which helps energize sperm as they travel towards the egg for fertilization.

When the prostate enlarges, it can press against the urethra and block the flow of urine, causing urinary frequency, urgency, and incomplete emptying of the bladder.

“When your life is disrupted, you realize the significance of all the things you can and can’t do,” said Outlaw, a 64-year-old Hampton, Va., native.

Outlaw is not alone in his struggles. As men age, it is common for their prostate to enlarge due to hormonal changes. About 50% of men aged 50 to 60 have BPH, and up to 90% of men over 80 have the condition.

Out of the 1.8 million people in the Hampton Roads region of Virginia, more than 174,000 are men aged 65 or older. That means around 87,000 likely have BPH and as many as 17,400 need surgical treatment.

“Realizing I was part of the statistics was an eye-opener,” said Outlaw. “You look around and ask:  why don’t people know about this? It’s because people don’t talk about it.”

Receiving treatment

Earlier this year, Outlaw underwent a relatively new procedure called prostatic artery embolization (PAE), which was approved by the FDA in 2017. It’s a minimally invasive outpatient procedure which shrinks the prostate by 10-40% within 3 months and improves urinary tract symptoms by 50-80%.

During the 1-2 hour procedure, the patient is moderately sedated while a tiny catheter is inserted through an artery in their groin. Tiny particles are then injected to block blood flow to the prostate gland, reducing its size. Patients go home the same day and can resume normal activities within a few days.

“My quality of life has improved 100-fold. I can go anywhere and do anything I want. It’s incredible,” said Outlaw, whose prostate reduced in size by 40%. “As quick and painless as it was and the results being what they are, I’d recommend it to anybody.”

Adam Lustig, M.D., an interventional radiologist, performing a prostatic artery embolization (PAE). He injects tiny particles into the artery to block blood flow to the prostate.

“I've had grown men cry during their follow-up appointment with me because they got their life back,” said Adam Lustig, M.D., an interventional radiologist. “The procedure is very well tolerated. Most men say if they had to do it again, they would because of the life-changing impact it’s had on them.”

Dr. Lustig is only one of a few physicians in Hampton Roads who is specially trained to perform PAEs. He performed Outlaw’s procedure and since 2017 has performed 300 PAEs at Sentara Norfolk General Hospital’s interventional radiology clinic. One hundred and fifty of those PAEs were performed last year and he is on track to do 130 this year, signaling the growing popularity of the procedure.

“Other surgical treatments for BPH involve going directly into the penis and it's usually pretty gruesome and there is a risk for bleeding and sexual dysfunction,” said Dr. Lustig. “PAE is by far the safest procedure out there and is as effective as other treatments.”

Overall, PAE does not have any negative impact on sexual function, in fact a small number of patients actually experience an improvement in their sexual function.

‘We don’t have to suffer’

A 2024 study by the American Psychological Association found that 63% of men believe societal expectations pressure them to avoid showing weakness, including discussing health concerns.

As an active-duty Marine for 22 years, Outlaw was used to putting on a brave face and toughing it out. In 2017, even though his BPH symptoms were crippling his ability to live, he still didn’t want to ask for help. 

As a U.S. Marine, Outlaw was taught to tough it out but says his wife’s encouragement led him to seek treatment. At right, Outlaw and his wife attend their grandson’s basketball game.

“One day, my wife looked at me and said, ‘You’re not bulletproof anymore. You need to see someone,’” said Outlaw. “I just looked at her and said, ‘Really?’ And she said, ‘That’s not a discussion, honey. That’s your command.’”

Three months after his PAE procedure, Outlaw is no longer suffering. He can enjoy quality time with his four children and six grandchildren without the constant interruption of needing to use the bathroom.

“Being ‘man enough’ is being man enough to talk about your problems. We don’t have to suffer. We can have much healthier lives if we just talk about it.”

To learn if prostate artery embolization is the right treatment for you, call the Sentara Norfolk General Hospital interventional radiology clinic at 757-388-3401.