In March 2016, the Brazilian Federal Council of Medicina (Conselho Federal de Medicina CFM), the authority in charge of professional regulation and medical licensing in the area of medicine in the country, stated that prostatic artery embolization can be used as a new, alternative treatment for symptomatic patients with benign prostatic hyperplasia. Interventional News spoke to Francisco Cesar Carnevale, associate professor of Medicine, University of São Paulo, Brazil, and director, Interventional Radiology Fellowship Programme, about this development.
Commenting on the process that led to the CFM decision, which makes Brazil the first country in which such a decision has been made, Carnevale said: “The first patients in whom prostatic artery embolization (with the aim of treating symptoms related to benign prostate hyperplasia) was used were treated at the Hospital das Clincas of the University of Sao Paulo (USP) in June 2008. Two patients with urinary retention treated by indwelling catheter and severe comorbidities were treated with embolization, as an alternative treatment to transurethral resection of the prostate (TURP). Both patients had the Foley catheter withdrawn a week after the embolization procedure and lower urinary tract symptoms (LUTS) improved significantly. Subsequetly, in 2013, after performing several clinical studies approved by the Ethical Committee at USP, we submitted a dossier to the CFM asking for recognition of embolization as a new procedure that can be used in clinical practice. In March 2016, after several discussions with members of the Brazilian Society of Interventional Radiology (SoBRICE) and the Brazilian Society of Urology (SBU), the CFM stated that prostatic artery embolization can be used as an alternative treatment for symptomatic patients due to benign prostatic hyperplasia.”
“Now, several centres (which have urologists and interventional radiologists working as a team) will be developed throughout Brazil with the aim of collecting data for a final approval and codification by health institutions,” he added.
This approval will influence the number of prostatic artery embolization procedures being performed in Brazil. “These will probably increase dramatically. There is a huge interest in prostate artery embolization from the interventional radiology community. The urology team coordinating this type of embolization at USP has really understood that it works. More than treating patients, the medical team at USP is keen to understand the results of long-term clinical follow-up. Around 250 patients have been treated at our institutions within the setting of a randomised, controlled trial,” Carnevale noted.
Commenting on what the latest evidence is showing regarding prostatic artery embolization, Carnevale said: “Around 2,000 procedures have been performed around the world. It has been shown that the procedure is safe and effective in treating patients with lower urinary tract symptoms related to enlarged prostates. The initial clinical success is reported at around 90%, and severe complications are rare. This is encouraging. Interventional radiologists should not treat any patient without discussing all the treatment alternatives within a team co-ordinated by urologists, and they should respect the patient’s preference. Many urologists have also begun mooting the idea of working together as a group. It is a good start and the same perspective has been reported by other interventional radiologists in different countries.”