Technical and Imaging Outcomes from the UK Registry of Prostate Artery Embolization (UK-ROPE) Study: Focusing on Predictors of Clinical Success
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The UK Registry of Prostate Artery Embolization (UK-ROPE) was a prospective, multicentre study comparing PAE against surgical therapies for symptomatic benign prostatic hyperplasia (BPH). A wealth of data was collected supplementary to the main study outcomes which provide a snapshot of UK PAE practice. We aimed to interpret these data in the hope of providing insight into factors which affect clinical outcome and radiation dose.
216 patients (mean age 66, mean IPSS 21.3) undergoing PAE at 20 British centres from July 2014 to January 2016 were prospectively followed up to 12 months with retrospective analysis of the data. Technical outcome was evaluated based on procedural and fluoroscopy times, skin dose and dose area product (DAP). Clinical outcome was evaluated through collection of Qmax, IPSS reduction and prostate volume reduction. Multiple analysis of variance (MANOVA) was used to assess the significance of various patients and procedural factors on clinical outcome and patient dose.
Significant predictors of technical outcome which affected patient skin dose included severity of CTA-detected atheroma (p < 0.001), the practitioner (p < 0.001) and use of protective coil embolization (p = 0.019). Predictors of clinical outcome included initial prostate size (dichotomized into groups > 80 ml and = <80 ml, d = 1, p = 0.0138), embolic agent (spherical particles < 300 nm performed best, p = 0.01) and number of arteries embolized (IPSS reduction of 32.9% in unilateral PAE versus 54.4% for bilateral PAE, p = 0.026).
We have identified several important factors which are associated with improved clinical outcome and increased patient dose which we hope will facilitate optimal patient selection and encourage improved embolization technique.
KeywordsPAE Prostate Embolization Predictor UK BPH
The UK-ROPE study was funded through multiple streams. The involvement of an independent academic evaluation centre ‘Cedar’ was funded through the National Institute for Health and Care Excellence (NICE). Procedure costs were covered either through local commissioning streams or through a grant from Cook Medical (Europe), where this was not possible.
Compliance with Ethical Standards
Conflict of interest
Nigel Hacking was in receipt of a research grant to run the UK-ROPE study from Cook Medical, has received honoraria from Boston Scientific and Celonova as a speaker and has been on Advisory boards for BTG. Tim Bryant has proctored for Boston Scientific and Terumo and has received speaker honorariums from Boston Scientific. Sachin Modi has received a speaker honorarium from Boston Scientific. The other authors declare no conflict of interest.
All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. Consent for publication was obtained for every individual person’s data included in the study.
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