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Effects of Prostatic Artery Embolization on the Dynamic Component of Benign Prostate Hyperplasia as Assessed by Ultrasound Elastography: A Pilot Series

  • André Moreira de AssisEmail author
  • Airton Mota Moreira
  • Francisco Cesar Carnevale
  • Antonio Sergio Zafred Marcelino
  • Luciana Mendes de Oliveira Cerri
  • Alberto Azoubel Antunes
  • Miguel Srougi
  • Giovanni Guido Cerri
Clinical Investigation Imaging
  • 18 Downloads
Part of the following topical collections:
  1. Imaging

Abstract

Purpose

To determine the effects of prostatic artery embolization (PAE) on prostatic elasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation.

Materials and Methods

This is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up.

Results

After PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, − 29.8%, p = 0.002) and in m/s (3.75 vs. 4.63, − 19.0%, p < 0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p < 0.05). All eight patients presented with significant LUTS improvement after PAE (p < 0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA).

Conclusions

Findings described in this study suggest that PAE significantly reduces prostatic EM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.

Keywords

Benign prostatic hyperplasia Prostate artery embolization Lower urinary tract symptoms Ultrasound Elastography 

Notes

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review board approved the study protocol.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.

References

  1. 1.
    Antunes AA, Carnevale FC, da Motta-Leal-Filho JM, Yoshinaga EM, Cerri LM, Baroni RH, et al. Clinical, laboratorial and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia. A prospective singe-center pilot study. Cardiovasc Interv Radiol. 2013;36:978–86.CrossRefGoogle Scholar
  2. 2.
    Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC, Furtado A, et al. Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol. 2012;23:1403–15.CrossRefGoogle Scholar
  3. 3.
    Bagla S, Martin CP, van Breda A, Sheridan MJ, Sterling KM, Papadouris D, et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol. 2014;25:47–52.CrossRefGoogle Scholar
  4. 4.
    de Assis AM, Moreira AM, de Paula Rodrigues VC, Yoshinaga EM, Antunes AA, Harward SH, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostate > 90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26:87–93.CrossRefGoogle Scholar
  5. 5.
    Gao YA, Huang Y, Zhang R, et al. prostatic arterial embolization versus transurethral resection of the prostate—a prospective, randomized, and controlled clinical trial. Radiology. 2014;270(3):920–8.CrossRefGoogle Scholar
  6. 6.
    Carnevale FC, Iscaife A, Yoshinaga EM, et al. Transurethral resection of the Prostate (TURP) versus original and PErFecTED Prostate Artery Embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Interv Radiol. 2016;39(1):44–52.CrossRefGoogle Scholar
  7. 7.
    Ray AF, Powell J, Speakman MJ, et al. Efficacy and safety of Prostate Artery Embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int. 2018.  https://doi.org/10.1111/bju.14249 [Epub ahead of print].Google Scholar
  8. 8.
    Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of Prostate Artery Embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27(8):1115–22.CrossRefGoogle Scholar
  9. 9.
    Carnevale FC, Moreira AM, Harward SH, et al. Recurrence of lower urinary tract symptoms following Prostate Artery Embolization for Benign Hyperplasia: single center experience comparing two techniques. Cardiovasc Interv Radiol. 2017;40(3):366–74.CrossRefGoogle Scholar
  10. 10.
    Moreira AM, de Assis AM, Carnevale FC, et al. A review of adverse events related to prostatic artery embolization for treatment of bladder outlet obstruction due to BPH. Cardiovasc Interv Radiol. 2017;40(10):1490–500.CrossRefGoogle Scholar
  11. 11.
    Wang XY, Zong HT, Zhang Y. Efficacy and safety of Prostate Artery Embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis. Clin Interv Aging. 2016;11(11):1609–22.CrossRefGoogle Scholar
  12. 12.
    Kuang M, Vu A, Athreya S. A systematic review of prostatic artery embolization in the treatment of symptomatic benign prostatic hyperplasia. Cardiovasc Interv Radiol. 2017;40:655–63.CrossRefGoogle Scholar
  13. 13.
    Uflacker A, Haskal ZJ, Bilhim T, et al. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol. 2016;27(11):1686–97.CrossRefGoogle Scholar
  14. 14.
    de Assis AM, Maciel MS, Moreira AM, de Paula Rodrigues VC, Antunes AA, Srougi M, et al. Prostate zonal volumetry as a predictor of clinical outcomes for Prostate Artery Embolization. Cardiovasc Interv Radiol. 2017;40:245–51.CrossRefGoogle Scholar
  15. 15.
    Zhai L, Madden J, Foo WC, et al. Acoustic radiation force impulse imaging of human prostates ex vivo. Ultrasound Med Biol. 2010;36:576–88.CrossRefGoogle Scholar
  16. 16.
    Zhai L, Madden J, Foo WC, et al. Characterizing stiffness of human prostates using acoustic radiation force. Ultrason Imaging. 2010;32:201–13.CrossRefGoogle Scholar
  17. 17.
    Zhai L, Polascik TJ, Foo WC, et al. Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration. Ultrasound Med Biol. 2012;38:50–61.CrossRefGoogle Scholar
  18. 18.
    Zhang M, Fu S, Zhang Y, et al. Elastic modulus of the prostate: a new non-invasive feature to diagnose bladder outlet obstruction in patients with benign prostatic hyperplasia. Ultrasound Med Biol. 2014;40:1408–13.CrossRefGoogle Scholar
  19. 19.
    Alan B, Utangaç M, Goya C, Daggulli M. Role of Acoustic Force Impulse (ARFI) elastography in determination of severity of benign prostate hyperplasia. Med Sci Monit. 2016;22:4523–8.CrossRefGoogle Scholar
  20. 20.
    Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovasc Interv Radiol. 2014;37:1602–5.CrossRefGoogle Scholar
  21. 21.
    Carnevale FC, Moreira AM. The “PErFecTED technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Interv Radiol. 2014;37:1602–5.CrossRefGoogle Scholar
  22. 22.
    Auffenberg GB, Helfand BT, McVary KT. Established medical therapy for benign prostatic hyperplasia. Urol Clin N Am. 2009;36:443–59.CrossRefGoogle Scholar
  23. 23.
    Foster HE, Barry MJ, Dahm P, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol. 2018.  https://doi.org/10.1016/j.juro.2018.05.048 [Epub ahead of print].Google Scholar
  24. 24.
    Bosch JL, Bangma CH, Groeneveld FP, Bohnen AM. The long-term relationship between a real change in prostate volume and a significant change in lower urinary tract symptom severity in population-based men: the Krimpen study. Eur Urol. 2008;53:819–25.CrossRefGoogle Scholar
  25. 25.
    Hattori T, Sugaya K. Mechanisms of action for α1-adrenoceptor blockers in storage symptoms with new insights into the micturition reflex. Life Sci. 2017;191:90–6.CrossRefGoogle Scholar
  26. 26.
    Frenk NE, Baroni RH, Carnevale FC, et al. MRI findings after prostatic artery embolization for treatment of benign hyperplasia. AJR Am J Roentgenol. 2014;203:813–21.CrossRefGoogle Scholar
  27. 27.
    Homma Y, Gotoh M, Yokoyama O, et al. Outline of JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol. 2011;18:741–56.CrossRefGoogle Scholar
  28. 28.
    Assis AM, Moreira AM, Carnevale FC. Angiographic findings or repeat prostatic artery embolization. J Vasc Interv Radiol. 2019.  https://doi.org/10.1016/j.jvir.2018.12.734 [Epub ahead of print].Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • André Moreira de Assis
    • 1
    • 2
    Email author
  • Airton Mota Moreira
    • 1
    • 2
  • Francisco Cesar Carnevale
    • 1
    • 2
  • Antonio Sergio Zafred Marcelino
    • 3
  • Luciana Mendes de Oliveira Cerri
    • 3
  • Alberto Azoubel Antunes
    • 4
  • Miguel Srougi
    • 4
  • Giovanni Guido Cerri
    • 3
    • 5
  1. 1.Interventional Radiology Department, Radiology InstituteUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  2. 2.Interventional Radiology DepartmentSírio-Libanês HospitalSão PauloBrazil
  3. 3.Radiology DepartmentSírio-Libanês HospitalSão PauloBrazil
  4. 4.Urology DepartmentUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  5. 5.Radiology InstituteUniversity of Sao Paulo Medical SchoolSão PauloBrazil

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