Prostate artery embolization: A treatment that replaces prostate surgery
Study of 1,550 patients shows prostatic artery embolization effective for a decade
Study
Prostate embolization (PAE) could become the standard of care procedure for the treatment of benign prostatic hyperplasia (BPH), proposed Tiago Bilhim (CHULC, Hospital Saint Louis, Lisbon, Portugal), due to "good clinical results" presented at the 2019 Annual Meeting of the European Society of Cardiovascular and Radiological Diseases (CIRSE; September 7-11, Barcelona, Spain).
The investigators set out to evaluate the outcomes of PAE in patients with BPH, presenting with moderate to severe lower urinary tract symptoms. The single-center retrospective study examined data from 1,550 patients prospectively collected between March 2009 and February 2019.
"Subjective and objective parameters were evaluated," said Bilhim. The International Prostate Symptom Score (IPSS), Quality of Life Score (QOL) and International Index of Erectile Function (IIEF-5) were classified as subjective measures, while the researchers also calculated changes in prostate volume (PV) using ultrasound, maximal urine flow (Qmax), post-void urine residue (PVR) and prostate-specific antigen (PSA) concentration. All were assessed before EAP, then one, six and 12 months after EAP, then annually for 10 years.
Clinical results
There was a statistically significant change from baseline in parameters assessed at all time scales. In the short term, defined as one to 12 months after PAE, the mean cumulative clinical success rate was 88.1% (extremes: 77.6 to 92.4%). In the medium term, two to five years after the procedure, this rate was 85.1% (extremes: 71.3 to 93.1%) and, in the long term, six to ten years after EAP, the mean cumulative clinical success rate was 76.8% (extremes: 69.1-84.6%). Bilhim described the evolution of the cumulative clinical success rate from short to long term - from 88.1% to 76.8% - as "a very slight decline" over ten years.
Average reduction in IPSS score was 13.5 ± 6.9 in the short term, 14.1 ± 7.3 in the medium term and 13.9 ± 8.7 in the long term.
Average improvement in quality of life was also constant over ten years: 1.8 ± 1.2 in the short term, 2.1 ± 1.3 in the medium term and 1.7 ± 1.5 in the long term. A reduction in prostate volume was also observed up to ten years, with an average long-term reduction of 16.9 ± 26.6cm3 and a short-term reduction of 18.3 ± 27.9cm3.
Of the 156 patients with acute urinary retention (AUR), 140 (89.7%) had the bladder catheter removed between two days and three months; 10 had repeated EAPs and six underwent surgery. For the 312 patients whose prostate volume was greater than 100 ml, the clinical success rate was high: in 80.7% of patients (252 individuals) in the short term; 77.6% of patients (242 individuals) in the medium term; 75.3% of patients (235 individuals) in the long term. Bilhim reported three major complications: bladder wall ischemia, perineal pain for three months without sequelae, and a patient with expelled prostate fragments and AUR treated by transurethral resection of the prostate (TURP) without sequelae.
Describing the technical results, Bilhim reported that, in 90% of patients (1,324 people), the interventionalist had gained access to the vascular system via the femoral artery. Since 2016, interventional radiologists at Saint-Louis Hospital in Lisbon, Portugal, had been using left radial access, so 10% of the cohort (148 patients) had experienced it. "It's our first-line approach," he said of the technique, adding that they were now using it "more and more".
