A single-centre report of mid- to long-term outcomes following prostate artery embolization (PAE) in a large cohort has found that the treatment shows significant and sustained relief from lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH).
In a paper published in the Journal of Interventional Radiology (JVIR), principal investigator Shivank Bhatia (Miller School of Medicine, Miami, USA) et al write that PAE has recently been recognised as a viable treatment for BPH, and has been included within the American Urological Association (AUA) treatment guidelines. Yet, despite its increasing recognition there is a scarcity of long-term research to support its efficacy.
Their study included 1,075 patients with moderate-to-severe LUTS or urinary retention who underwent PAE in the period between January 2014 and July 2023. Patients were assessed at one, three, six and 12 months post-PAE and then yearly thereafter. Bhatia and colleagues used several modes to assess patient progress, including: the International Prostate Symptom Score (IPSS), quality of life (QoL) score, International Index of Erectile Function Score (IIEF-5), prostate-specific antigen (PSA), prostate volume (PV), post-void residual (PVR), benign prostatic obstruction (BPO) medication usage, urinary catheter status, and further prostate interventions. In addition, adverse events were recorded using the Society of Interventional Radiology adverse event (SIR-AE) severity classification.
Mean follow-up was 458.4 days, and the average patient age was 70.4 years. Median prostate volume was reported as 107 grams, and median pre-procedure IPSS, QoL, IIEF-5 and PSA were 23 (18–28), 5 (4–6), 17 (10–21), and 4.7 (2.6–8), respectively. In the LUTS subgroup, at 1–3, 6–12 and 48–60 months, the median IPSS was 7 (4–12, p<0.001), 6 (3–11, p<0.001), and 9 (4–15, p<0.001). QoL scores were 2 (1–2, p<0.001), 1(0–2, p<0.001), 2 (0–3, p<0.001) at the same timepoints. Of patients in the urinary retention cohort, 119 (94%) out of 126 patients were catheter-free at the three-month follow-up.
Up to 60 months post-PAE, 90 patients required reintervention. Overall, 65.5% of patients were BPO-medication free at one year following initial PAE. In this cohort, 7% of patients with an SIR-AE severity score of severe, which included three patients with transient ischaemic-attacks, two with urosepsis (treated via inpatient setting with intravenous-antibiotics), and finally, two patients with prostate sloughing. All adverse events resolved without sequelae, state Bhatia et al.
In their large cohort with long-term longitudinal follow-up, the authors report the significant improvement in LUTS symptoms, highlighting that 94% of catheter-dependant patients at baseline becoming catheter-free at three months.
They state that PAE is validated as safe and effective for the treatment of BPH, and, given its “efficacy and favourable safety profile”, should be considered equal to traditional surgical treatments. Bhatia and colleagues add that PAE should be more broadly integrated within clinical practice as a standard option for BPH.
