Scientific press: what studies say about prostate embolization

What level of evidence for prostatic embolization?

The question comes up often, and it is a legitimate one: a recent technique naturally inspires caution. The answer has three parts.

First, the'prostatic artery embolization was the subject of randomized trials, the highest level of evidence in medicine. It has been compared to medical treatment, surgery, and even a placebo procedure.

Then, these essays were synthesized into systematic reviews and meta-analyses, which aggregate the results of several independent studies.

Finally, some national evaluation agencies have spoken out. In the United Kingdom, NICE has issued a recommendation dedicated to prostatic embolization for urinary disorders related to benign prostatic hyperplasia.

Our team's work

Beyond clinical practice, the team publishes on the technique itself: quality criteria for embolization, arterial anatomy, and optimization of the procedure.

• Using prostate contrast retention (PCR) as the procedural endpoint in prostatic artery embolization for benign prostatic hyperplasia

  European Radiology · 2021 · 31(12):9150-9160

  First demonstration that an objective criterion for procedure termination — the retention of contrast medium in the gland — is associated with clinical outcome. In other words, it is not just about embolizing, but the quality and distal nature of the embolization.

  View the publication
• Prostate Artery Embolization: Challenges, Tips, Tricks, and Perspectives

  Journal of Personalized Medicine · 2022 · 13(1):87

  Review dedicated to the technical difficulties of prostatic embolization: anatomical variants, communications with neighboring territories, catheterization strategies. It serves as a reference for operators facing complex anatomies.

  View the publication
• Combination of an adhesive with microspheres and risk of recurrence

  Article being published

  Internal follow-up of the first 100 patients treated with the combination of glue and microspheres, with a recurrence risk below 5 %. These data have not yet been published; they are presented here as such.

Meet the team and their backgrounds · View annotated clinical cases

Efficacy: what the trials show

• PARTEM: prostatic embolization versus medical treatment

  The Lancet Regional Health – Europe · 2023

  Phase 3 multicenter randomized trial conducted in ten French hospitals in patients with an adenoma greater than 50 grams resistant to alpha-blockers. It positions embolization as a credible alternative to combined drug therapy.

• Prostate artery embolization versus transurethral resection of the prostate (TURP)

  The BMJ · 2018

  A randomized trial comparing the two techniques. Comparable urinary functional outcomes on the primary endpoints, with a major difference regarding ejaculation: approximately 16 % cases of anejaculation after embolization versus 52 % cases after resection.

• Systematic reviews and meta-analyses

  Several international journals · since 2019

  They aggregate the published series and confirm a significant improvement in the IPSS score and urinary flow rate, with a very low major complication rate. They also highlight the variability of protocols among teams.

Let's note what these works actually measure: the improvement of IPSS score, urinary flow rate, and quality of life. These are the criteria that matter to the patient, more than just the reduction in prostate volume.

Sexual function: the best-documented difference

This is the point on which the data are most consistent. Resection techniques act on the bladder neck and prostatic urethra, which explains the frequency of retrograde ejaculation. Embolization, which acts via the blood vessels, does not affect these structures.

Comparative trials show a considerable difference in this criterion, ranging from 16 % to 52 % in the randomized study cited above. No adverse effects on erectile function have been documented following embolization.

This explains why many patients discover the technique precisely by looking to preserve their sexuality. Prostate-related sexual disorders

Technique and embolization agents

The scientific debate is less about the principle than about the modalities: what particle size, what agent, what stopping criterion, what delivery method.

• Particle size and clinical outcomes

  International Literature · since 2019

  Several studies compare microsphere sizes. The conclusions do not entirely converge: some report a benefit of smaller particles regarding the distal nature of the embolization, while others report more postoperative effects. This is still an open subject.

  View the publication
• Femoral approach or radial approach

  Journal of Personalized Medicine · 2022

  The wrist approach appears feasible in the vast majority of cases, without any additional risk compared to the femoral approach. It improves patient comfort, allowing them to get up immediately.

• Large prostate volumes

  Journal of Vascular and Interventional Radiology · 2018

  Series dedicated to prostates of 80 milliliters and larger, long considered difficult to treat. The results support the indication of embolization in these volumes, where surgery becomes more burdensome.

Chronic prostatitis: an indication under evaluation

• Transcatheter embolization in refractory chronic prostatitis

  CardioVascular and Interventional Radiology · 2024

  Case series of 44 patients with chronic prostatitis resistant to conventional treatments. Significant improvement in pelvic pain and urinary symptoms in the majority of them, with a low complication rate.

  View the publication

In this indication, the technique remains Under evaluation The data are encouraging, but lack the long-term follow-up that embolization enjoys in benign prostatic hyperplasia. Embolization in chronic prostatitis

International literature

The references below appear in our literature review. They cover the foundational series, safety evaluations, and work dedicated to large prostate volumes.

• Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients

  Cardiovascular and Interventional Radiology · 2010

  First work describing prostatic embolization as an intentional treatment for benign hypertrophy. This is the starting point of the technique.

• Prostatic arterial embolization to treat benign prostatic hyperplasia

  Journal of Vascular and Interventional Radiology · 2011

  First published series. It establishes the feasibility of the technique and paves the way for larger-scale work.

• Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate — a prospective, randomized, and controlled clinical trial

  Radiology · 2014

  First randomized trial directly comparing embolization to transurethral resection, the surgical reference standard.

• Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients

  Journal of Vascular and Interventional Radiology · 2016

  Series of 630 patients with extended follow-up. It documents the durability of the results and provides the first solid data on recurrence.

• Randomized clinical trial of prostatic artery embolization versus a sham procedure for benign prostatic hyperplasia

  Randomized sham-controlled trial

  Compared to a placebo procedure, the most stringent protocol there is, it rules out the hypothesis of a mere expectation effect and significantly strengthens the level of evidence.

• Prostate artery embolization in patients with prostate volumes of 80 mL or more: a single-institution retrospective experience of 93 patients

  Journal of Vascular and Interventional Radiology · 2018

  Series dedicated to large prostates, long considered difficult to treat. It supports the indication of embolization for these volumes, where surgery becomes more burdensome.

• Outcome after prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia

  Acta Radiologica · 2018

  Evaluation of functional outcomes and technique tolerability in routine practice.

• Prostate artery embolisation: an initial experience from an Indian perspective

  Polish Journal of Radiology · 2018

  Illustration of the international dissemination of the technique and its reproducibility outside of pioneer centers.

• Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis

  Springer · 2019

  Systematic review and meta-analysis of published series. It confirms the improvement in the IPSS score and urinary flow rate, with a very low rate of major complications.

• Society of Interventional Radiology multisociety consensus position statement on prostatic artery embolization

  Journal of Vascular and Interventional Radiology · 2019

  Joint position statement by several learned societies defining the indications, selection criteria, and performance standards for the technique.

• Intraprostatic arterial anatomy and implications for embolization

  Works dedicated to anatomy · since 2012

  Several publications describe the anatomical variants of the prostatic arteries and the communications with neighboring territories. They establish the necessity for preoperative mapping.

See these anatomical variants on real cases

How to read a scientific study

Not all publications carry the same weight. Three guidelines help navigate them without being a doctor.

• The randomized trial randomizes the treatment received, which eliminates selection bias. This is the highest level of evidence.
• The meta-analysis It aggregates several independent studies. It provides an overview but depends on the quality of the works it compiles.
• The case series reports the experience of a team, without comparison. Useful for describing a technique, insufficient to claim superiority.

Beware also of figures cited without a source, and of those that concern a different criterion from the one you are interested in: a «success» rate can refer to symptom improvement, volume reduction, or the absence of further surgery—three distinct things.

Have your file proofread

Send your reports and exams. Our team will tell you what is missing from the assessment and what options can be considered in your situation.

Related pages