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Using prostate contrast retention (PCR) as the procedural endpoint in prostatic artery embolization for benign prostatic hyperplasia

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The failure rate following prostate artery embolization (PAE) is around 20%, which may in part result from inadequate embolization. Prostate contrast retention (PCR) adequacy on immediate post-embolization cone-beam CT may provide better assessment of embolization completeness than arterial contrast stasis seen on fluoroscopy alone. The aim of this study was to evaluate outcomes of PAE using PCR adequacy as the procedural endpoint.

Methods

A retrospective cohort study of all PAE cases using this technique at a single large volume center was conducted. Following initial embolization of the main prostatic arteries, if PCR was inadequate, additional embolization was performed. Technical success (adequate PCR) was defined as > 75% global prostate gland contrast staining. Clinical success was determined in accordance to CIRSE standards of practice.

Results

One hundred sixty-five patients (mean age 68 ± 8.4 years) underwent PAE from June 2017 to March 2019. Technical and clinical success rates were 98.8% and 96.4% respectively. Clinical success rate was significantly higher in patients with adequate PCR. International Prostate Symptom Scores (IPSS) and Quality of Life (QoL) scores significantly improved at 1-, 3-, 6-, and 12-month follow-up when compared to baseline. Prostate volume (PV) and post-voiding residual bladder volume were significantly reduced at 3, 6, and 12 months in comparison to baseline. Mild (Clavien-Dindo grade I/II) and moderate (grade III) complication rates were 12.1% and 3.6% respectively.

Conclusions

By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.

Key Points

• By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.

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Abbreviations

BPH:

Benign prostatic hyperplasia

CBCT:

Cone-beam computer tomography

CIRSE:

The Cardiovascular and Interventional Radiological Society of Europe

DSA:

Digital subtraction angiography

IIEF:

International Index of Erectile Function

IPSS:

International Prostate Symptom Scores

LUTS:

Lower urinary tract symptoms

PAE:

Prostate artery embolization

PCR:

Prostate contrast retention

PErFecTED:

Proximal embolization first then embolize distal

PSA:

Prostate-specific antigen

PV:

Prostate volume

PVR:

Post-void residual

QoL:

Quality of Life scores

TURP:

Transurethral resection of the prostate

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Interventional Radiology, American Hospital of Paris, Neuilly-sur-Seine, Paris, France

    Antoine Hakimé & Jean Luc Sarrazin

  2. Department of Radiology, Hôpital Sud Francilien, Corbeil-Essonnes, France

    Antoine Hakimé & Viseth Kuoch

  3. Department of Interventional Radiology, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK

    Jimmy Kyaw Tun

  4. Department of Urology, American Hospital of Paris, Neuilly-sur-Seine, Paris, France

    François Haab

  5. Department of Surgical Radiology, Institut Gustave Roussy, Villejuif, France

    Thierry De Baere & Lambros Tselikas

Authors
  1. Antoine Hakimé
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  2. Jimmy Kyaw Tun
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  3. François Haab
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  4. Jean Luc Sarrazin
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  5. Thierry De Baere
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  6. Lambros Tselikas
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  7. Viseth Kuoch
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Correspondence to Antoine Hakimé.

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The scientific guarantor of this publication is Antoine HAKIME.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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Hakimé, A., Tun, J.K., Haab, F. et al. Using prostate contrast retention (PCR) as the procedural endpoint in prostatic artery embolization for benign prostatic hyperplasia. Eur Radiol 31, 9150–9160 (2021). https://doi.org/10.1007/s00330-021-08063-w

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  • DOI: https://doi.org/10.1007/s00330-021-08063-w

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