This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH).
Methods:
A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Qmax) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines.
Results:
Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% (P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure (P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Qmax (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure (P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B).
Conclusion:
Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.
NickelJCDowneyJBénardF, et al.The Canadian benign prostatic hyperplasia audit study (CanBas). J Can Urol Assoc J. 2008;2(4):367–373.
2.
ParsonsJK. Benign prostatic hyperplasia and male lower urinary tract symptoms: epidemiology and risk factors. Curr Bladder Dysfunct Rep. 2010;5(4):212–218.
3.
NickelJCAaronLBarkinJEltermanDNachabéMZornKC. Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update. Can Urol Assoc J. 2018;12(10):303–312.
4.
ChristidisDMcGrathSPereraMManningTBoltonDLawrentschukN. Minimally invasive surgical therapies for benign prostatic hypertrophy: the rise in minimally invasive surgical therapies. Prostate Int. 2017;5(2):41–46.
5.
WilliamsDRyceA. Minimally-invasive treatments for lower urinary tract symptoms in people with benign prostatic hyperplasia: a review of clinical effectiveness. In CADTH rapid response report: Summary with critical appraisal; 2019. Ottawa: Canadian Agency for Drugs and Technologies in Health.
6.
BrownADStellaSFSimonsME. Minimally invasive treatment for benign prostatic hyperplasia: economic evaluation from a standardized hospital case costing system. Cardiovasc Intervent Radiol. 2019;42(4):520–527.
7.
BaglaSSmirniotopoulosJBOrlandoJCVan BredaAVadlamudiV. Comparative analysis of prostate volume as a predictor of outcome in prostate artery embolization. J Vasc Interv Radiol. 2015;26(12):1832–1838.
8.
de AssisAMMoreiraAMde Paula RodriguesVC, et al.Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates > 90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26(1):87–93.
9.
PiscoJMBilhimTPinheiroLC, et al.Medium- and Long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27(8):1115–1122.
10.
BhatiaSSinhaVKHarwardSGomezCKavaBRParekhDJ. Prostate artery embolization in patients with prostate volumes of 80 ml or more: a single-institution retrospective experience of 93 patients. J Vasc Interv Radiol. 2018;29(10):1392–1398.
11.
AbtDHechelhammerLMüllhauptG, et al.Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338.
12.
InsaustiISáez de OcárizAGalbeteA, et al.Randomized comparison of prostatic artery embolization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia. J Vasc Interv Radiol. 2020;31(6):882–890.
13.
CarnevaleFCMoreiraAMAntunesAA. The “PErFecTED Technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Intervent Radiol. 2014;37(6):1602–1605.
14.
KhalilzadehOBaerlocherMOShynPB, et al.Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 2017;28(10):1432–1437.e3.
15.
ChuteCGPanserLAGirmanCJ, et al.The prevalence of prostatism: A population-based survey of urinary symptoms. J Urol. 1993;150(1):85–89.
16.
Camara-LopesGMattediRAntunesAA, et al.The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia. Int Braz J Urol. 2013;39(2):222–227.
17.
KurbatovDRussoGILepetukhinA, et al.Prostatic artery embolization for prostate volume greater than 80 cm3: Results from a single-center prospective study. Urology. 2014;84(2):400–404.
18.
RayAFPowellJSpeakmanMJ, et al.Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int. 2018;122(2):270–282.
19.
MacleanDHarrisMLongJModiSBryantTJHackingN. The first 48 consecutive patients with 3-year symptom score follow-up post-prostate artery embolization (pae) at a single-centre university hospital. Cardiovasc Intervent Radiol. 2020;43(3):459–465.
PiscoJMBilhimTCostaNV, et al.Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia [Formula presented]. Eur Urol. 2020;77(3):354–362.
22.
McWilliamsJPBilhimTACarnevaleFC, et al.Society of Interventional Radiology multisociety consensus position statement on prostatic artery embolization for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia. J Vasc Interv Radiol. 2019;30(5):627–637.e1.
23.
CarnevaleFCIscaifeAYoshinagaEMMoreiraAMAntunesAASrougiM. Transurethral resection of the prostate (TURP) versus original and perfected prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Intervent Radiol. 2016;39(1):44–52.
24.
Garcia-MonacoRDGarateguiLGOnoratiMVRosascoNMPeraltaOA. Cadaveric specimen study of prostate microvasculature: implications for arterial embolization. J Vasc Interv Radiol. 2019;30(9):1471–1479.e3.
25.
MathevosianSPlotnikANMcWilliamsJP. Prostate artery embolization for giant prostatic enlargement: short-term efficacy and safety. J Vasc Interv Radiol. 2019;30(11):1820–1823.
26.
GeevargheseRHardingJParsonsNHutchinsonCParsonsC. The relationship of embolic particle size to patient outcomes in prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-regression. Clin Radiol. 2020;75(5):366–374.
27.
BilhimTPiscoJPereiraJA, et al.Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. Radiology. 2016;281(1):289–300.
28.
BilhimTCostaNVTorresDPiscoJCarmoSOliveiraAG. Randomized clinical trial of balloon occlusion versus conventional microcatheter prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol. 2019;30(11):1798–1806.
29.
AyyagariRPowellTStaibL, et al.Case-control comparison of conventional end-hole versus balloon-occlusion microcatheter prostatic artery embolization for treatment of symptomatic benign prostatic hyperplasia. J Vasc Interv Radiol. 2019;30(9):1459–1470.
30.
UflackerAHaskalZJBilhimTPatrieJHuberTPiscoJM. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol. 2016;27(11):1686–1697.e8.
31.
ThulasidasanNKokHKElhageOClovisSPopertRSabharwalT. Prostate artery embolisation: an all-comers, single-operator experience in 159 patients with lower urinary tract symptoms, urinary retention, or haematuria with medium-term follow-up. Clin Radiol. 2019;74(7):569.e1–569.e8.
