Prostatic artery embolization is a minimally invasive technique used to treat symptoms related to benign prostatic hyperplasia (BPH). But one question often comes up among patients considering this procedure: Are the results long-lasting?
A study on 1,550 patients, followed for up to ten years after their embolization, provides particularly interesting evidence. The results show a lasting improvement in urinary symptoms and quality of life, with a clinical success rate that remains high several years after the procedure.
A study of 1,550 patients
The results were presented by interventional radiologist Tiago Bilhim at the 2019 annual meeting of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
The objective was to evaluate the outcomes of prostatic artery embolization in men presenting with benign prostatic hyperplasia associated with moderate to severe urinary symptoms.
The study analyzed data from 1,550 patients treated between March 2009 and February 2019.
What elements were evaluated?
Researchers tracked several indicators to measure both the symptoms experienced by the patients and the objective outcomes of the treatment:
- the IPSS score, which measures the severity of urinary symptoms; ;
- quality of life ;
- erectile function via the IIEF-5 score; ;
- prostate volume ;
- the maximum urinary flow rate ;
- the volume of urine remaining in the bladder after urination; ;
- the PSA level.
These parameters were evaluated before embolization, and then at one month, six months, and twelve months after the procedure. Annual follow-up was subsequently performed in some patients for a period of up to ten years.
Results that endure over time
One of the main findings of this study concerns the durability of the improvement achieved after embolization.
Short-term: 88.1 1Q3Q clinical success
Between one and twelve months after the procedure, the average reported clinical success rate was 88,1 %.
This period generally corresponds to the time when the gradual reduction in prostate volume begins to produce a clear improvement in urinary symptoms.
Patients may notice, in particular:
- a stronger urinary stream ;
- a decrease in frequent urges to urinate; ;
- fewer night wakings; ;
- a better sensation of bladder emptying.
Between two and five years: 85.1 % success rate
In the medium term, that is between two and five years after embolization, the average rate of clinical success remained 85,1 %.
The decrease observed compared to the first year therefore appears limited.
These results suggest that when a patient responds favorably to embolization, the improvement can be sustained for several years.
Ages 6 to 10: 76.8 % clinical success rate
In patients with a follow-up of between six and ten years, the average reported clinical success rate was still 76,8 %.
Even if a gradual decrease in efficacy may appear over the years, the observed results indicate that a significant proportion of patients maintain a long-term clinical benefit.
A lasting improvement in urinary symptoms
The IPSS score is one of the main tools used to measure the severity of symptoms associated with benign prostatic hyperplasia.
The higher the score, the more significant the urinary disorders.
In this study, the mean decrease in the IPSS score reached:
- 13.5 short-term points ;
- 14.1 points in the medium term ;
- 13.9 long-term points.
These results show that the improvement in urinary symptoms observed after the procedure can remain relatively stable several years after embolization.
Quality of life remains improved for up to ten years
Benign prostatic hyperplasia is not limited to a simple urinary flow problem.
Repeated night-time awakenings, urgent urges, the constant need to look for a bathroom, or the sensation of incomplete bladder emptying can have a major impact on sleep and daily activities.
The study also shows a lasting improvement in the quality of life score after embolization.
This improvement was observed both during the first year and several years after the procedure.
A lasting reduction in prostate volume
Embolization works by selectively reducing the blood supply to a part of the prostate.
Deprived of part of its blood supply, the prostate tissue gradually decreases in volume.
In this study, this reduction was still observable several years after treatment.
The average decrease in prostate volume was approximately 18.3 cm³ short-term and of 16.9 cm³ long-term.
This volume reduction helps decrease the compression exerted on the urethra and thus facilitates the flow of urine.
What results for very large prostates?
Embolization is also of interest in certain patients whose prostate is particularly large.
In this study, 312 patients had a prostate larger than 100 ml.
The clinical success rates reported in this group were:
- 80.7 % (short-term) ;
- 77.6 1Q3Q (medium term) ;
- 75.3 % (long-term).
These data show that a large prostate volume does not necessarily prevent obtaining a lasting improvement after embolization.
However, the choice of treatment remains individual and depends notably on the anatomy of the prostatic arteries, the severity of the symptoms, and the patient's general condition.
Embolization and urinary retention
The study also included 156 patients with acute urinary retention, that is to say an inability to urinate normally requiring the insertion of a catheter.
After embolization, Of these 156 patients, 140—or 89.7 %—were able to remove their urinary catheter between two days and three months after the procedure.
Ten patients underwent a new embolization and six ultimately required surgery.
These results show that embolization can also be considered in certain situations of urinary retention, following specialized medical evaluation.
What complications were reported?
Among the 1,550 patients studied, the authors reported three major complications:
- an ischemia of the bladder wall; ;
- persistent perineal pain for three months, without sequelae; ;
- the expulsion of prostatic fragments associated with urinary retention, ultimately treated by transurethral resection of the prostate.
Like any medical procedure, embolization is therefore not entirely without risks.
However, it remains a minimally invasive technique that does not require a surgical incision of the prostate.
An arterial intervention
Embolization consists of introducing a microcatheter into the arteries in order to reach the branches that vascularize the prostate.
In this historical study, access was primarily achieved via the femoral artery.
Techniques have evolved since then, and access via the radial artery at the wrist can also be used in certain centers and for certain patients.
The choice of the access route depends on the patient's anatomy and the habits of the interventional radiology team.