A study recently published in Cardiovascular and Interventional Radiology has, for the first time, identified adenomatous-dominant benign prostatic hyperplasia as a predictor of clinical success following prostate artery embolization.
The investigators, Mark W Little, and CR Tapping from the Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, set out to investigate the clinical impact of performing prostate artery embolization on patients with adenomatous-dominant benign prostatic hyperplasia.
Twelve patients from the ongoing STREAM (Prostatic artery embolization for the treatment of benign prostatic hyperplasia) trial were identified as having adenomatous-dominant benign prostatic hyperplasia. The condition was defined as two or more adenomas within the central gland of ≥1cm diameter on multiparametric MRI. These patients were age matched with patients from the STREAM cohort, without adenomatous-dominant benign prostatic hyperplasia. Patients were followed up with repeat multiparametric MRI at three months and one year. International prostate symptom score (IPSS), international index for erectile function (IIEF), and quality of life assessment from the IPSS and EQ-5D-5S questionnaires were recorded before embolization, at six weeks, three months, and one year.
The mean age of patients was 68 years and all had embolization as a day-case procedure. The technical success in the cohort was 96%. There was a significant reduction in prostate volume following embolization with a median reduction of 34% in the group with adenomatous-dominant benign prostatic hyperplasia, compared to a mean volume reduction of 22% in the other group (p=0.04). There was a significant reduction in IPSS in the group with adenomatous-dominant benign prostatic hyperplasia group following embolization when compared with the control (p=0.01). IPSS quality of life scores significantly improved in the adenomatous-dominant benign prostatic hyperplasia group compared to the control group (p=0.007). There was no deterioration in sexual function in either group after the procedure.
“Adenomatous dominant benign prostatic hyperplasia is more responsive to embolization due to the increased vascularity of these benign lesions within the gland, resulting in preferential embolic flow into the adenomatous tissue,” Little told Interventional News.