Prostatic Artery Embolization Works for Enlarged Prostate

Cumulative rates of success were 87.2% at 3 months, 80.2% at 18, and 72.3% at 36.
Cumulative rates of success were 87.2% at 3 months, 80.2% at 18, and 72.3% at 36.

SAN DIEGO—Minimally invasive prostatic artery embolization (PAE) is effective in reducing frequent urination and other symptoms associated with an enlarged prostate, according to findings presented at the Society for Interventional Radiology annual meeting.

In addition, compared with surgery, PAE was associated with similar outcomes and enabled patients to leave the hospital three to six hours after treatment with immediate symptom relief. PAE was not associated with an increased risk of urinary incontinence or sexual dysfunction, the study found.

The study, by João Martins Pisco, MD, PhD, of Saint Louis Hospital in Lisbon, Portugal, and colleagues, included 500 consecutive patients with benign prostatic hyperplasia (BPH) and moderate to severe lower urinary tract symptoms (LUTS). All had failed medical therapy for at least 6 months and underwent PAE.

Patients ranged in age from 45 -89 years (mean 69.5 years) and the prostate volume ranged from 35-269 cc (mean 92 cc). Patients were evaluated before and at 1, 3, 6, and every 6 months after the procedure. Nonspherical polyvinyl alcohol (PVA) particles were used. The follow up control ranged from 3 to 52 months (mean 20.1 months).

All patients were controlled at short-term at least at 3 months, 319 patients over 1,5 years (mid term) and 48 patients over 3 years (long term). From the last group 12 patients have been followed over 4.5 years, the researchers reported.

Nine technical failures occurred, and 22 patients were lost to follow up. From the 469 controlled patients, there were 107 (22.8%) clinical failures, 60 (12.8%) at short term, 34 (10.6%) at mid-term and 13 (27.1%) at long term. 

Cumulative rates of clinical success were 87.2% at 3 months (short term), 80.2% at 18 months (medium term), and 72.3% at 36 months (long term). Two patients suffered major complications, including a bladder wall ischemia, which was treated with simple surgery, and uncomfortable perineal pain lasting for 3 months. Both patients remained without sequelae. No case of sexual dysfunction or urinary incontinence was reported.

"PAE is a safe, well tolerated, and efficient outpatient procedure, an alternative to surgery, for patients with BPH refractory to medical therapy, with good short, mid-term and long term results, without sexual dysfunction or urinary incontinence," the investigators reported in their study abstract.

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