Prostatic Artery Embolization Eases BPH Symptoms
SAN FRANCISCO—Benign prostatic hyperplasia (BPH) may be safely treated with prostatic artery embolization (PAE), according to a new study presented at the 37th Annual Scientific Meeting of the Society of Interventional Radiology (SIR).
PAE is associated with few serious adverse side effects and may reduce prostate volume by more than 30%, researchers reported.
“These new findings provide hope for those who might not be candidates for transurethral resection of the prostate and may allow them to avoid serious complications that sometime result from surgery, such as impotence, retrograde ejaculation and urinary incontinence,” said study investigator Francisco Cesar Carnevale, MD, PhD, Professor and Chief of the Interventional Radiology Section at the Hospital das Clínicas of the Faculty of Medicine at the University of São Paulo, Brazil. “This could mean that more men have a chance at getting their lives back.”
Dr. Carnevale and his colleagues conducted a prospective, single site phase 2 study to investigate whether PAE could improve both quality of life and lower urinary tract symptoms (LUTS) in men with BPH. The study included 11 men with acute urinary retention due to BPH who had been managed with medical treatment and indwelling urethral catheters and were waiting to undergo surgery.
Using a 1 mm diameter micro-catheter threaded into the prostatic arteries, surgeons performed 12 PAE procedures under local anesthesia in 11 patients using resin microspheres as embolizing agents. The men ranged in age from 59 to 78 years, with a mean age of 68.5 years. Dr. Carnevale's team used magnetic resonance imaging (MRI) and ultrasound to analyze the prostate and fluoroscopy (digital subtraction angiogram) for the anatomy of the prostate arteries (Figure 1).
Technical success (bilateral PAE) was achieved in 75% of patients. Clinical success (catheter removal and symptom improvement) was achieved in 91%. Patients urinated spontaneously from 4-25 days (mean 12.1 days) after catheter removal.
The most frequent symptoms related to PAE were mild pain and inflammation in the anal, urethral, and retropubic areas. The researchers observed no major complications; no instances of erectile dysfunction were reported. The investigators followed up patients for up to 45 months and found no recurrences.
(A) Pre-embolization MRI. Axial post-contrast T1- weighted depicting the enlarged prostate due to central gland nodules. Note the presence of
the urethral catheter (white arrow).
(B) 6 months post-embolization MRI. Axial post-contrast T1-weighted depicting bilateral avascular areas in the central
gland (white arrows), and reduction of the prostate size.
(C) 18 months post-embolization MRI. Axial post-contrast T1-weighted showing a slight reduction
in size and conspicuity of bilateral avascular areas in the central gland and (white arrows), and further reduction of the prostate size.
At the time of treatment, the men's prostate size ranged from 30–90 grams and all patients reported acute urinary retention. Both ultrasound and MRI revealed an overall 30% volume reduction in prostate size at the final follow-up visit (Figure 2).
All patients reported overall clinical improvement in LUTS after 12 months of follow-up and reported a high degree of satisfaction and increased quality of life after treatment. In addition, all patients had higher urinary flow and reduced detrusor pressure and post-void residual volume compared with pre-embolization urodynamic studies.
“More than a quarter of a million men undergo surgery for an enlarged prostate every year, at an estimated annual costs of over $1 billion per year because current therapies, including medication, just aren't working for them,” said Ziv Haskal, MD, Professor of Radiology and Surgery at the University of Maryland School of Medicine in Balitmore. He was among a group of SIR members who traveled to Brazil to learn about the treatment and to begin the process that may bring this treatment to the United States.
“I saw first-hand how these men responded to treatment. With the possibility of faster recovery, on an outpatient basis, and with no bladder catheters, reduced symptoms, improved urination and fewer potential side effects, prostatic artery embolization could signal a bold new change in accepted prostate therapy.”