Promising preliminary results for prostatic artery embolization in younger men

Nigel Hacking
Nigel Hacking

Nigel Hacking, consultant radiologist, Southampton University Hospitals NHS Trust, Southampton, UK, spoke to Interventional News about using polyvinyl alcohol foam embolization particles (Cook) for prostatic artery embolization in younger men with benign prostatic hyperplasia. The data were presented at GEST 2013 (May, Prague, Czech Republic).

Could you summarise the results of your study?
I presented the preliminary results of a pilot study of 20 patients with enlarged prostates who had undergone prostatic artery embolization in Southampton in 2012. These preliminary results are very encouraging, particularly in younger men with large symptomatic prostates.

Is prostatic artery embolization a step forward for treating benign prostatic hyperplasia?
Yes, it gives interventional radiologists a non-surgical option to treat symptomatic prostatic disease without surgery as a day case procedure and with a seemingly very low incidence of side-effects and complications. For a young (55 to 65 year old) sexually active man with a prostate larger than 80ml in volume, prostatic artery embolization is a very attractive alternative to open prostatectomy.

Are the particles suitable for older patients (70+ years)?
With increasing age, there is typically deterioration in the state of the pelvic arteries which makes their catheterisation and subsequent embolization difficult. Whilst we do not have a hard and fast cut-off age, more men over the age of 75 will have unsuitable arteries shown on planning CT angiography and may be turned down for prostate artery embolization.

What would your ideal cohort ‰Û¬of patients for the use of the ‰Û¬particles be?
Men with moderate to severe lower urinary tract symptoms (LUTS), secondary to benign prostatic enlargement who are failing or have failed medical therapy and are looking for a more effective treatment. The ideal man is in the 55–70 years age group with a large prostate gland and large healthy pelvic arteries. These cases, when embolized, appear to do best.

Could this be done in an office setting?
This is a day case or outpatient procedure, but requires a high-quality interventional suite, preferably with coned-beam CT facility. A well-equipped office may well be suitable if the interventional radiologist is experienced in complex embolization and microcatheter techniques.

What side-effects could use of the particles carry?
Non-target embolization is always a risk with any embolization and so adequate experience and training along with proctoring and careful attention to detail is essential.

What is planned in the future to further investigate the particles?
A joint UK prostate artery embolization registry is being planned under the control of the British Society of Interventional Radiology (BSIR), the British Association of Urological Surgeons (BAUS) and the National Institute for Health and Clinical Excellence (NICE). This is due to commence in early 2014 and will start to answer many questions about safety and efficacy of the procedure as well as seeing which patients are likely to benefit from prostatic artery embolization. A matched cohort of patients undergoing conventional prostatic surgery will be compared alongside the prostatic artery embolization patients and this should inform future randomised controlled trials of the procedure leading to its more widespread introduction into practice in the UK over the next few years.