The UK’s NICE recommends prostate artery embolization for selected men with benign prostatic hyperplasia

The National Institute for Health and Care Excellence (NICE), which provides national guidance and advice to improve health and social care, has decided that the current evidence on the safety and efficacy of prostate artery embolization for benign prostatic hyperplasia is adequate to support the use of this procedure on the National Health Service (NHS).

Prostate artery embolization can serve as a bridge between medical therapy and surgery, say experts on the topic. The procedure is a minimally invasive alternative to transurethral resection of prostate (TURP) or laser prostatectomy.

NICE first looked at prostate artery embolization in 2013, but felt that more research was required to determine whether the procedure was effective and safe. Since 2013, NICE has worked with the British Society of Interventional Radiology (BSIR) and the British Association of Urological Surgeons (BAUS) to coordinate the UK ROPE study. The study compared embolization to conventional prostate surgery. It found embolization provided a clinically and statistically significant improvement in symptoms and quality of life for men with enlarged prostate.

In light of this study and other new evidence, NICE has updated its guidance. It now says embolization can be offered to patients. The procedure should be carried out by an interventional radiologist with specific training and expertise.

Nigel Hacking, consultant interventional radiologist at University Hospital Southampton, UK, said: “The UK-ROPE project has taken several years and required extra training of professionals working in 18 centres across England and Scotland.”

The updated NICE guidance notes that patient selection should be done by a urologist and an interventional radiologist and that embolization is a “technically demanding procedure [that] should only be done by an interventional radiologist with specific training and expertise in prostatic artery embolization.”

The potential benefits of prostate artery embolization compared with surgery include fewer complications, avoiding a general anaesthetic and that it may be done as a day case procedure.

The BSIR has issued a press release on NICE’s decision stating that the recommendation from NICE could revolutionise the way men are treated.

“Traditional surgical options for this condition can have significant complications, including surgical bleeding and retrograde ejaculation, which can have upsetting effects on men. Prostate artery embolization, the new alternative, as shown in the UK-ROPE registry headed up by Nigel Hacking, can now be offered to men in the UK as an alternative treatment for men who would prefer to avoid surgical options,” the release states.

The BSIR release further adds:

“This is a significant development for men with moderate to severe lower urinary tract symptoms from their enlarged prostate glands.  The new guidelines published on 25 April 2018, approved embolization under ‘Standard’ conditions meaning that this treatment could now become a real treatment option for men in the UK.

“Men will still need to be seen by an urologist to exclude cancer and other causes for their symptoms and working as a close knit team they will then liaise with their interventional radiology colleagues to choose the most suitable candidates for this treatment. Embolization is not going to replace TURP, but it will provide a bridge between medication, once this is ineffective or causing side-effects, and surgery. In some men it will provide a definitive solution, but in others there may still be a need for surgical options, including some less invasive procedures such as the Urolift procedure. Tailoring a patient’s needs to their treatment rather than offering a one-size-fits-all policy is a major advance.”

“An enlarged prostate can have a severe impact on the lives of those living with it and complications related to treatment can effect men for the rest of their lives. It is important patients receive all the treatment options and not just conventional surgery. The BSIR, working closely with BAUS and NICE, are very pleased to promote access to this new option,” said Trevor Cleveland, president of the BSIR.