Download PDF
CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2021; 5(02): 091-098
DOI: 10.1055/s-0041-1730083
Original Article

Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

James F. Pike
1   University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
,
William F. Abel
1   University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
,
Tyler B. Seckel
1   University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
,
Christine M.G. Schammel
2   Pathology Associates, Greenville, South Carolina, United States
,
William Flanagan
1   University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
3   Department of Surgery, Division of Urology, Prisma Health Upstate, Greenville, South Carolina, United States
,
A. Michael Devane
1   University of South Carolina School of Medicine Greenville, Greenville, South Carolina, United States
4   Department of Radiology, Interventional Radiology, Prisma Health Upstate, Greenville, South Carolina, United States
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Purpose Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for patients with prostates >80 mL and has demonstrated lower morbidity rates. We sought to evaluate PAE at a single tertiary medical center. Methods A retrospective review of all patients who underwent PAE was completed. Demographic, clinicopathologic, procedure, and outcome data were collected to include international prostatic symptom score (IPSS) and quality of life (QoL) assessments. Results The pre-PAE mean prostate-specific antigen (PSA) was 8.4 ng/mL, mean prostate volume was 146.9 mL (9% >200 mL), and mean postvoid residual (PVR) was 208.2 mL (21.9% 200–300 mL). IPSS mean was 19.8 and QoL was “mostly dissatisfied.” Following PAE, mean PSA was reduced by 3.2 ng/mL (38.1%, p = 0.3014), the mean prostate volume reduction was 59.2 mL (40.3%, n = 19, p < 0.0001), and the average PVR reduction was 150.3 mL (72.2%, n = 27, p = 0.0002). Average IPSS score was also lower (11.9; 60.1%, n = 25, p < 0.0001) and QoL was reduced to “mostly satisfied” (p < 0.0001). Technical success was 100% with 24% minor morbidities. Conclusion PAE is a successful treatment for patients with BPH resulting in large prostates that are not good candidates for simple prostatectomy, providing optimal care with less operative and postoperative complications.

Keywords

prostatic artery embolization - benign prostatic hyperplasia - prostate volume >80 mL


Publication History

Article published online:
30 June 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Oelke M, Bachmann A, Descazeaud A. et al. European Association of Urology. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013; 64 (01) 118-140
    CrossrefPubMedGoogle Scholar
  • 2 Kirby M, Chapple C, Jackson G. et al. Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co-diagnosis. Int J Clin Pract 2013; 67 (07) 606-618
    CrossrefPubMedGoogle Scholar
  • 3 Cornu JN, Ahyai S, Bachmann A. et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 2015; 67 (06) 1066-1096
    CrossrefPubMedGoogle Scholar
  • 4 Yu X, Elliott SP, Wilt TJ, McBean AM. Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies. J Urol 2008; 180 (01) 241-245
    CrossrefPubMedGoogle Scholar
  • 5 Ou R, You M, Tang P, Chen H, Deng X, Xie K. A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80 mL. Urology 2010; 76 (04) 958-961
    CrossrefPubMedGoogle Scholar
  • 6 Gratzke C, Schlenker B, Seitz M. et al. Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 2007; 177 (04) 1419-1422
    CrossrefPubMedGoogle Scholar
  • 7 Enikeev D, Morozov A, Taratkin M. et al. Systematic review of the endoscopic enucleation of the prostate learning curve. World J Urol 2020; DOI: 10.1007/s00345-020-03451-1.
    CrossrefPubMedGoogle Scholar
  • 8 Carnevale FC, Moreira AM, Antunes AA. The “PErFecTED technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2014; 37 (06) 1602-1605
    CrossrefPubMedGoogle Scholar
  • 9 Carnevale FC, Antunes AA, da Motta Leal Filho JM. et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 2010; 33 (02) 355-361
    CrossrefPubMedGoogle Scholar
  • 10 Pisco J, Bilhim T, Pinheiro LC. et al. Prostate embolization as an alternative to open surgery in patients with large prostate and moderate to severe lower urinary tract symptoms. J Vasc Interv Radiol 2016; 27 (05) 700-708
    CrossrefPubMedGoogle Scholar
  • 11 Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. 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 (01) 44-52
    CrossrefPubMedGoogle Scholar
  • 12 Gao YA, Huang Y, Zhang R. et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate–a prospective, randomized, and controlled clinical trial. Radiology 2014; 270 (03) 920-928
    CrossrefPubMedGoogle Scholar
  • 13 Abt D, Hechelhammer L, Müllhaupt G. 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
    CrossrefPubMedGoogle Scholar
  • 14 Parsons JK, Barry MJ, Dahm P. et al. Benign Prostatic Hyperplasia: Surgical Management of Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms (2018, Amended 2019, 2020).. American Urological Association 2020; 1-35
    PubMedGoogle Scholar
  • 15 Yu SCH, Cho CC, Hung EHY, Chiu PKF, Yee CH, Ng CF. Prostate artery embolization for complete urinary outflow obstruction due to benign prostatic hypertrophy. Cardiovasc Intervent Radiol 2017; 40 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 16 Pisco JM, Bilhim T, Pinheiro LC. 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 (08) 1115-1122
    CrossrefPubMedGoogle Scholar
  • 17 Lin YT, Amouyal G, Correas JM. et al. Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? MRI evaluation of zonal anatomy and infarction after PAE. Eur Radiol 2016; 26 (10) 3466-3473
    CrossrefPubMedGoogle Scholar
  • 18 National Comprehensive Cancer Network. Prostate cancer (version 4.2019). https://www.nccn.org/patients/guidelines/content/PDF/prostate-patient.pdf. Accessed August 30, 2020
    PubMed
  • 19 Ballstaedt L, Woodbury B. Bladder Post Void Residual Volume. StatPearls Publishing. 2020. https://www.ncbi.nlm.nih.gov/books/NBK539839/. Accessed August 30, 2020
    PubMed
  • 20 Young S, Golzarian J. Prostate embolization: patient selection, clinical management and results. CVIR Endovasc 2019; 2 (01) 7
    CrossrefPubMedGoogle Scholar
  • 21 Khalilzadeh O, Baerlocher MO, Shyn PB. 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
    CrossrefPubMedGoogle Scholar
  • 22 Centers for Disease Control and Prevention. All About Adult BMI. 2020. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Accessed August 30, 2020
    PubMed
  • 23 United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects 2019: Highlights. ST/ESA/SER.A/423. 2019. https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf. Accessed August 30, 2020
    PubMed
  • 24 Lee SWH, Chan EMC, Lai YK. The global burden of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis. Sci Rep 2017; 7 (01) 7984
    CrossrefPubMedGoogle Scholar
  • 25 Parikesit D, Mochtar CA, Umbas R, Hamid ARH. The impact of obesity towards prostate diseases. Prostate Int 2016; 4 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 26 Hwang EC, Kim SO, Nam DH. et al. Men with hypertension are more likely to have severe lower urinary tract symptoms and large prostate volume. Low Urin Tract Symptoms 2015; 7 (01) 32-36
    CrossrefPubMedGoogle Scholar
  • 27 Gutman S, Merrick GS, Butler WM. et al. Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy. BJU Int 2006; 97 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 28 Somani BK, Hacking N, Bryant T. et al. Prostate artery embolization (PAE) for benign prostatic hyperplasia (BPH). BJU Int 2014; 114 (05) 639-640
    CrossrefPubMedGoogle Scholar
  • 29 Bilhim T, Pisco J, Rio Tinto H. et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol 2013; 36 (02) 403-411
    CrossrefPubMedGoogle Scholar
  • 30 Ray AF, Powell J, Speakman MJ. 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 (02) 270-282
    CrossrefPubMedGoogle Scholar
  • 31 Pariser JJ, Pearce SM, Patel SG, Bales GT. National trends of simple prostatectomy for benign prostatic hyperplasia with an analysis of risk factors for adverse perioperative outcomes. Urology 2015; 86 (04) 721-725
    CrossrefPubMedGoogle Scholar
  • 32 Cizman Z, Isaacson A, Burke C. Short- to midterm safety and efficacy of prostatic artery embolization: a systematic review. J Vasc Interv Radiol 2016; 27 (10) 1487-1493.e1
    CrossrefPubMedGoogle Scholar
  • 33 Westwood J, Geraghty R, Jones P, Rai BP, Somani BK. Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol 2018; 10 (11) 327-333
    CrossrefPubMedGoogle Scholar
  • 34 Rukstalis D, Rashid P, Bogache WK. et al. 24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham. BJU Int 2016; 118 (Suppl. 03) 14-22
    CrossrefPubMedGoogle Scholar
  • 35 Rieken M, Bachmann A. Update on Greenlight laser vaporization (PVP) 2014. World J Urol 2015; 33 (04) 531-537
    CrossrefPubMedGoogle Scholar
  • 36 Jones P, Alzweri L, Rai BP, Somani BK, Bates C, Aboumarzouk OM. Holmium laser enucleation versus simple prostatectomy for treating large prostates: results of a systematic review and meta-analysis. Arab J Urol 2016; 14 (01) 50-58
    CrossrefPubMedGoogle Scholar
  • 37 Zell MA, Abdul-Muhsin H, Navaratnam A. et al. Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc). World J Urol 2021; 39 (01) 129-134
    CrossrefPubMedGoogle Scholar