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The STREAM Trial (Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia) 24-Month Clinical and Radiological Outcomes

  • Clinical Investigation
  • Embolisation (Arterial)
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To establish factors predictive of success prior to Prostate Artery Embolization (PAE) with MRI imaging.

Materials and Methods

A prospective cohort study of 50 patients with Benign Prostatic Hyperplasia (BPH) were treated with PAE in a single institution. Patients had moderate to severe symptoms of BPH refractory to medical management for at least 6 months. Patients were imaged with multiparametric MRI imaging pre-PAE and at 3 months, 12 months and 24 months post-PAE. Clinical success was measured with IPSS, IIEF and EQ-5D-5L quality of life questionnaires.


The technical success was 48/50 (96%).The mean age of the group was 67 (range 54–83). The mean IPSS score pre-PAE was 21 and at 24 months was 8 (p < 0.001). There was no deterioration in erectile function. The mean volume of the prostate post-PAE was reduced at 3 and 12 months post-PAE but not significantly different at 24 months. This did not correlate with the IPSS score. Patients with median lobe enlargement has similar symptomatic improvement as those without median lobe enlargement. Internally within the prostate patients with adenomatous-dominant BPH initially did better than patients with stromal enlargement; however, at 24 months patients with stromal enlargement of the prostate improved greatest. Initial volume of the prostate was not a good predictor of clinical success.


PAE is a safe and effective treatment strategy for treating men with BPH. Patients with Adenomatous BPH clinically do better until 12 months but not at 24 months. Initial prostate volume does not affect outcome, and patients with median lobe enlargement do as well as those without.

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The authors wish to acknowledge the Royal College of Radiologists, UK, and Oxfordshire Health Services Research Committee (OHSRC) (Grant No. 1170) for funding the study. The results of this study were presented at CIRSE 2019 in Barcelona as an oral presentation.


This study was funded by a Royal College of Radiologists Pump Priming Grant, UK, and Oxfordshire Health Services Research Committee (OHSRC) Grant (No. 1170).

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Correspondence to Charles R. Tapping.

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Conflict of interest

CRT has received honoraria from Merit Medical and Boston Scientific. Author MWL has received a research grants and honoraria from Merit Medical and Crannmed.

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

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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. A statement on the Institutional Review Board (IRB) approval of your study must be also included in this section.

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Informed consent was obtained from all individual participants included in the study. For all research involving human subjects, informed consent to participate in the study should be obtained from participants (or their parent or legal guardian in the case of children under 16).

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Tapping, C.R., Little, M.W., Macdonald, A. et al. The STREAM Trial (Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia) 24-Month Clinical and Radiological Outcomes. Cardiovasc Intervent Radiol 44, 436–442 (2021).

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