Early embolization results encouraging for small volume prostatic hyperplasia

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A study that set out to assess the safety and efficacy of prostate artery embolization in small volume benign prostatic hyperplasia (<50cc) revealed that the procedure appears to offer positive clinical benefits for patients out to six months.

Sandeep Bagla, Inova Alexandria Hospital, Alexandria, USA, presented the results at the 27th annual International Symposium on Endovascular Therapy (ISET, 31 January–5 February, Hollywood, USA).

“Traditional urologic surgery of small-volume benign prostatic hyperplasia is associated with high failure rates and complications such as bladder neck strictures and contractures. While prostate artery embolization is postulated to be effective secondary to gland size reduction, we hypothesise that it may be equally effective in patients with small volume glands,” the investigators wrote in the abstract.

Subsequent to an Institutional Review Board approval, the researchers carried out a retrospective study of 78 consecutive prostate artery embolization patients from January 2011 to July 2014. They evaluated the patients at baseline; one; three; and six months using the American Urological Association symptom index (AUA-SI)  including quality of life related symptoms, International Index of Erectile Function (IIEF), and prostate imaging (magnetic resonance imaging, ultrasound, or computed tomography at baseline).

“We stratified the patients into two groups: Group 1 consisted of patients with prostate volume of less than 50cc and Group 2 consisted of those patients whose prostate volumes greater than 50cc. We analysed patients individually from baseline to one, three, and six months and between groups at each follow-up to assess for differences in outcome,” Bagla said.

“There were no significant differences in baseline age, AUA-SI scores, quality of life scores or IIEF scores between the groups. Patients were around 65 years of age, and had mean AUA-SI scores of 26.4. They also scored very poorly in terms of quality of life scores,” he further noted.

For the 16 patients in Group one the baseline volumes averaged around 37cc.  For the 62 patients in Group 2, prostate volumes averaged 108.5cc.

“We achieved technical success in all patients in Group 1 and 59/62 in Group 2, with two unilateral embolizations and one unsuccessful procedure secondary to bilateral atherosclerotic occlusion in the latter group.

Data was available for 77 patients and the researchers observed a statistically significant reduction in AUA-SI scores in both groups from baseline to one, three and six months.  “In Group 1, we saw a reduction from a score at baseline of 27.2 to 12.7 at one month, 12.0  at three months and 11.2 at  six months (p<0.0006). In Group 2, we saw a reduction from the score at baseline from 26.1 to 15.3, 14.4, and 14.9 at one, three and six months respectively (p<0.0001),” Bagla said.

These results prompted the investigators to conclude that the procedure could offer crucial benefit to those patients with limited surgical options. Future study aimed at evaluating recurrence rates is suggested, they noted.

Portugal group to present mid- and long-term clinical outcomes

Joao-Martins Pisco, Hospital Saint Louis, Lisbon, Portugal, and team are to present the medium- and long-term clinical outcome of prostate artery embolization in 460 patients with benign prostatic hyperplasia at the Society of Interventional Radiology’s (SIR’s) upcoming Annual Scientific Meeting (28 February–5 March 2015, Atlanta, USA).

 

Pisco’s group will demonstrate that in this large cohort, there were less than 2% technical failures and that a statistically significant improvement of all evaluated parameters was observed, over time.

 
This has led the investigators to conclude that prostatic artery embolization is a safe, well-tolerated, and efficient outpatient procedure, for patients with benign prostatic hyperplasia and moderate to severe lower urinary tract symptoms. The team from Portugal note that their research demonstrated good mid-term and long-term results and no sexual dysfunction associated with the procedure.