Prostate Artery Embolization with 4D-CT

Abstract

Prostate artery embolization (PAE) is a technically challenging angiographic therapy that has been shown to have excellent clinical outcomes for men with benign prostatic hyperplasia and lower urinary tract symptoms. Although clinical outcomes have been well documented, several questions remain regarding various technical details of the procedure. This article is a brief review of indications and technical parameters of PAE as well as commonly debated topics throughout the literature. Finally, the article serves to report tips and tricks from a high-volume center.

Keywords

benign prostatic hyperplasia - therapeutic embolization - interventional radiology

Publication History

Article published online:
19 August 2024

• References

• 1 Roehrborn CG. Pathology of benign prostatic hyperplasia. Int J Impot Res 2008; 20 (Suppl. 03) S11-S18
• 2 Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol 2005; 7 Suppl 9 (Suppl. 09) S3-S14
• 3 Barry MJ, Fowler Jr FJ, Bin L, Pitts III JC, Harris CJ, Mulley Jr AG. The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol 1997; 157 (01) 10-14 , discussion 14–15
• 4 Barry MJ, Fowler Jr FJ, O'leary MP. et al; Measurement Committee of the American Urological Association. The American Urological Association Symptom Index for Benign Prostatic Hyperplasia. J Urol 2017; 197 (2S): S189-S197
• 5 Abrams P, Cardozo L, Fall M. et al; Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21 (02) 167-178
• 6 McVary KT. BPH: epidemiology and comorbidities. Am J Manag Care 2006; 12 (5, Suppl): S122-S128
• 7 Egan KB. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: prevalence and incident rates. Urol Clin North Am 2016; 43 (03) 289-297
• 8 Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2005; 173 (04) 1256-1261
• 9 Cornelis FH, Bilhim T, Hacking N, Sapoval M, Tapping CR, Carnevale FC. CIRSE standards of practice on prostatic artery embolisation. Cardiovasc Intervent Radiol 2020; 43 (02) 176-185
• 10 Pisco JM, Pinheiro LC, Bilhim T, Duarte M, Mendes JR, Oliveira AG. Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 2011; 22 (01) 11-19 , quiz 20
• 11 Sandhu JS, Bixler BR, Dahm P. et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 2024; 211 (01) 11-19
• 12 Abt D, Müllhaupt G, Hechelhammer L. et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic hyperplasia: 2-yr outcomes of a randomised, open-label, single-centre trial. Eur Urol 2021; 80 (01) 34-42
• 13 Uflacker A, Haskal ZJ, Bilhim T, Patrie J, Huber T, Pisco JM. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2016; 27 (11) 1686-1697.e8
• 14 Vogl TJ, Zinn A, Elhawash E, Alizadeh LS, Nour-Eldin NA, Naguib NNN. MR angiography-planned prostatic artery embolization for benign prostatic hyperplasia: single-center retrospective study in 56 patients. Diagn Interv Radiol 2021; 27 (06) 725-731
• 15 Bagla S, Rholl KS, Sterling KM. et al. Utility of cone-beam CT imaging in prostatic artery embolization. J Vasc Interv Radiol 2013; 24 (11) 1603-1607
• 16 Barral M, Lassalle L, Gardavaud F. et al. Virtual injection software reduces radiation exposure and procedural time of prostatic artery embolization performed with cone-beam CT. J Vasc Interv Radiol 2024; 35 (03) 409-415
• 17 Naidu SG, Narayanan H, Saini G. et al. Prostate artery embolization - review of indications, patient selection, techniques and results. J Clin Med 2021; 10 (21) 5139
• 18 Loffroy R, Guillen K, Salet E. et al. prostate artery embolization using N-butyl cyanoacrylate glue for urinary tract symptoms due to benign prostatic hyperplasia: a valid alternative to microparticles?. J Clin Med 2021; 10 (14) 3161
• 19 Salet E, Crombé A, Grenier N. et al. Prostatic artery embolization for benign prostatic obstruction: single-centre retrospective study comparing microspheres versus N-butyl cyanoacrylate. Cardiovasc Intervent Radiol 2022; 45 (06) 814-823
• 20 Hijazi BA, Shi HB, Liu S, Alqurashi TA, Sabri ZJ. N-butyl cyanoacrylate glue versus nonspherical polyvinyl alcohol particles for prostatic arterial embolization to treat benign prostatic hyperplasia: safety and efficacy. Urol J 2023; 20 (04) 261-268
• 21 Bilhim T, Pisco J, Pereira JA. 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 (01) 289-300
• 22 Torres D, Costa NV, Pisco J, Pinheiro LC, Oliveira AG, Bilhim T. Prostatic artery embolization for benign prostatic hyperplasia: prospective randomized trial of 100-300 μm versus 300-500 μm versus 100- to 300-μm + 300- to 500-μm embospheres. J Vasc Interv Radiol 2019; 30 (05) 638-644
• 23 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
• 24 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
• 25 Mirakhur A, McWilliams J. Prostate artery embolization for benign prostatic hyperplasia. Imaging Med 2015;7(02):
• 26 Sapoval M, Thiounn N, Descazeaud A. et al; PARTEM Study Group. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. Lancet Reg Health Eur 2023; 31: 100672
• 27 Peacock J, Sikaria D, Maun-Garcia L, Javedan K, Yamoah K, Parikh N. A proof-of-concept study on the use of prostate artery embolization before definitive radiation therapy in prostate cancer. Adv Radiat Oncol 2020; 6 (03) 100619
• 28 Parikh N, Keshishian E, Manley B. et al. Effectiveness and safety of prostatic artery embolization for the treatment of lower urinary tract symptoms from benign prostatic hyperplasia in men with concurrent localized prostate cancer. J Vasc Interv Radiol 2021; 32 (07) 1053-1061
• 29 Parikh N, Keshishian E, Sharma A. et al. Prostatic artery embolization is safe and effective for medically recalcitrant radiation-induced prostatitis. Adv Radiat Oncol 2020; 5 (05) 905-909
• 30 Parikh N, Manley B, Pow-Sang J, Yamoah K. A review of the role of prostatic artery embolization in the management of post-radiation prostatitis. AME Med J 2022; 7 (00)
• 31 Parikh N, Acharya V, Bhatia S. Prostate artery embolization - adverse events and peri-procedural management. Tech Vasc Interv Radiol 2020; 23 (03) 100692
• 32 Isaacson AJ, Fischman AM, Burke CT. Technical feasibility of prostatic artery embolization from a transradial approach. AJR Am J Roentgenol 2016; 206 (02) 442-444
• 33 Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical variants in prostate artery embolization: a pictorial essay. Cardiovasc Intervent Radiol 2017; 40 (09) 1321-1337
• 34 Bibok A, Kis B, Parikh N. Does the use of a hybrid 4D angio-CT system significantly impact procedure time for prostate artery embolization?. J Vasc Intervent Radiol 2021; 32 (5, Suppl, S18)
• 35 Jazayeri-Moghaddas O, Parikh N. Novel predictive model for amount of embolic used as a percent of prostate size during PAE. J Vasc Intervent Radiol 2022; 33 (6, Suppl, S51)
• 36 Galla N, Maron SZ, Voutsinas N. et al. Adjunctive coil embolization of the prostatic arteries after particle embolization for prostatic artery embolization. Cardiovasc Intervent Radiol 2021; 44 (12) 1994-1998