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Reasons to consider prostatic artery embolization

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Abstract

Purpose

Prostatic artery embolization (PAE) has emerged as a truly minimally invasive treatment option for patients with lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) over the last few years and is now supported by evidence-based international guidelines. Here, we provide an overview on the profile of PAE based on the most relevant and recent literature.

Methods

A comprehensive review of literature on PAE was conducted on PubMed–Medline. The most relevant literature was summarized narratively.

Results

While there is still a lack of long-term data, efficacy and safety data have been published for the short to mid-term. As with any minimally invasive technique, relief of bladder outlet obstruction is less pronounced after PAE compared to more invasive resective techniques. This is likely to be associated with higher re-intervention rates during the longer term. However, due to its beneficial safety profile, PAE represents an interesting option for many patients and could fill a niche between pharmacotherapy and formal surgical intervention. Given its unique treatment approach, i.e. endovascular instead of transurethral, PAE has a clearly different profile compared to other minimally invasive treatments. Performance with local anesthesia with possible continuation of anticoagulant drugs and no upper prostate size limit are the most important advantages of PAE.

Conclusion

PAE represents a valuable supplement in the treatment armamentarium of LUTS/BPH if patients are selected appropriately.

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References

  1. Speakman MJ, Cornu JN, Gacci M et al (2019) What is the required certainty of evidence for the implementation of novel techniques for the treatment of benign prostatic obstruction? Eur Urol Focus 5(3):351–356. https://doi.org/10.1016/j.euf.2019.05.014

    Article  PubMed  Google Scholar 

  2. Emberton M, Marberger M, de la Rosette J (2008) Understanding patient and physician perceptions of benign prostatic hyperplasia in Europe: the prostate research on behaviour and education (PROBE) survey. Int J Clin Pract 62(1):18–26. https://doi.org/10.1111/j.1742-1241.2007.01635.x

    Article  CAS  PubMed  Google Scholar 

  3. Gravas S, Cornu JN, Gacci M, et al. (2020) EAU Guidelines on Management on Non-neurogenic Male LUTS. https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/.

  4. McVary KT, Roehrborn CG, Avins AL, et al. American Urological Association Guideline: management of benign prostatic hyperplasia (BPH). Revised, 2010. https://www.auanet.org benign-prostatichyperplasia-(2010-reviewed-and-validity-confirmed-2014).

  5. Thomas AW, Cannon A, Bartlett E et al (2005) The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int 96(9):1301–1306. https://doi.org/10.1111/j.1464-410X.2005.05815.x

    Article  PubMed  Google Scholar 

  6. Martins Pisco J, Pereira J, Rio Tinto H et al (2012) How to perform prostatic arterial embolization. Tech Vasc Interv Radiol 15(4):286–289. https://doi.org/10.1053/j.tvir.2012.09.002

    Article  PubMed  Google Scholar 

  7. Mordasini L, Hechelhammer L, Diener PA et al (2018) Prostatic artery embolization in the treatment of localized prostate cancer: a bicentric prospective proof-of-concept study of 12 patients. J Vasc Interv Radiol 29(5):589–597. https://doi.org/10.1016/j.jvir.2018.01.766

    Article  PubMed  Google Scholar 

  8. Zumstein V, Betschart P, Vetterlein MW et al (2019) Prostatic artery embolization versus standard surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol Focus 5(6):1091–1100. https://doi.org/10.1016/j.euf.2018.09.005

    Article  PubMed  Google Scholar 

  9. Carnevale FC, Iscaife A, Yoshinaga EM et al (2016) 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 Intervent Radiol 39(1):44–52. https://doi.org/10.1007/s00270-015-1202-4

    Article  PubMed  Google Scholar 

  10. Gao YA, Huang Y, Zhang R et al (2014) Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate–a prospective, randomized, and controlled clinical trial. Radiology 270(3):920–928. https://doi.org/10.1148/radiol.13122803

    Article  PubMed  Google Scholar 

  11. Abt D, Hechelhammer L, Mullhaupt G et al (2018) Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 361:k2338. https://doi.org/10.1136/bmj.k2338

    Article  PubMed  PubMed Central  Google Scholar 

  12. Insausti I, Saez de Ocariz A, Galbete A et al (2020) Randomized comparison of prostatic artery embolization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 31(6):882–890. https://doi.org/10.1016/j.jvir.2019.12.810

    Article  PubMed  Google Scholar 

  13. Pisco JM, Bilhim T, Costa NV et al (2019) Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol. https://doi.org/10.1016/j.eururo.2019.11.010

    Article  PubMed  Google Scholar 

  14. Shim SR, Kanhai KJ, Ko YM et al (2017) Efficacy and safety of prostatic arterial embolization: systematic review with meta-analysis and meta-regression. J Urol 197(2):465–479. https://doi.org/10.1016/j.juro.2016.08.100

    Article  PubMed  Google Scholar 

  15. McWilliams JP, Bilhim TA, Carnevale FC et al (2019) Society of interventional radiology multisociety consensus position statement on prostatic artery embolization for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia: from the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Societe Francaise de Radiologie, and the British Society of Interventional Radiology: Endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol 30(5):627–637. https://doi.org/10.1016/j.jvir.2019.02.013

    Article  PubMed  Google Scholar 

  16. Mullhaupt G, Hechelhammer L, Diener PA et al (2019) Ejaculatory disorders after prostatic artery embolization: a reassessment of two prospective clinical trials. World J Urol. https://doi.org/10.1007/s00345-019-03036-7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zumstein V, Binder J, Gusewell S et al (2020) Radiation exposure during prostatic artery embolisation: a systematic review and calculation of associated risks. Eur Urol Focus. https://doi.org/10.1016/j.euf.2020.04.012

    Article  PubMed  Google Scholar 

  18. Schegerer A, Loose R, Heuser LJ et al (2019) Diagnostic reference levels for diagnostic and interventional X-ray procedures in Germany: update and handling. Rofo 191(8):739–751. https://doi.org/10.1055/a-0824-7603[publishedOnlineFirst:2019/01/22]

    Article  PubMed  Google Scholar 

  19. Madersbacher S, Lackner J, Brossner C et al (2005) Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol 47(4):499–504. https://doi.org/10.1016/j.eururo.2004.12.010

    Article  PubMed  Google Scholar 

  20. Wang M, Guo L, Duan F et al (2016) Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a comparative study of medium- and large-volume prostates. BJU Int 117(1):155–164. https://doi.org/10.1111/bju.13147[publishedOnlineFirst:2015/04/09]

    Article  PubMed  Google Scholar 

  21. Maclean D, Harris M, Drake T et al (2018) Factors predicting a good symptomatic outcome after prostate artery embolisation (PAE). Cardiovasc Intervent Radiol 41(8):1152–1159. https://doi.org/10.1007/s00270-018-1912-5[publishedOnlineFirst:2018/02/28]

    Article  CAS  PubMed  Google Scholar 

  22. Abt D, Mullhaupt G, Mordasini L et al (2019) Outcome prediction of prostatic artery embolization: post hoc analysis of a randomized, open-label, non-inferiority trial. BJU Int 124(1):134–144. https://doi.org/10.1111/bju.14632

    Article  PubMed  Google Scholar 

  23. du Pisanie J, Abumoussa A, Donovan K et al (2019) Predictors of prostatic artery embolization technical outcomes: patient and procedural factors. J Vasc Interv Radiol 30(2):233–240. https://doi.org/10.1016/j.jvir.2018.09.014[publishedOnlineFirst:2019/02/06]

    Article  PubMed  Google Scholar 

  24. Mullhaupt G, Hechelhammer L, Engeler DS et al (2019) In-hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial. BJU Int 123(6):1055–1060. https://doi.org/10.1111/bju.14660

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bagla S, Smirniotopoulos J, Orlando J et al (2017) Cost analysis of prostate artery embolization (PAE) and transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. Cardiovasc Intervent Radiol 40(11):1694–1697. https://doi.org/10.1007/s00270-017-1700-7

    Article  PubMed  Google Scholar 

  26. Ray AF, Powell J, Speakman MJ et al (2018) 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 122(2):270–282. https://doi.org/10.1111/bju.14249

    Article  PubMed  Google Scholar 

  27. Kannel WB, Wolf PA, Benjamin EJ et al (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82(8A):2N-9N. https://doi.org/10.1016/s0002-9149(98)00583-9[publishedOnlineFirst:1998/11/11]

    Article  CAS  PubMed  Google Scholar 

  28. Yu SC, Cho CC, Hung EH et al (2017) Prostate artery embolization for complete urinary outflow obstruction due to benign prostatic hypertrophy. Cardiovasc Intervent Radiol 40(1):33–40. https://doi.org/10.1007/s00270-016-1502-3[publishedOnlineFirst:2016/11/18]

    Article  PubMed  Google Scholar 

  29. Bhatia S, Sinha VK, Kava BR et al (2018) Efficacy of prostatic artery embolization for catheter-dependent patients with large prostate sizes and high comorbidity scores. J Vasc Interv Radiol 29(1):78–84. https://doi.org/10.1016/j.jvir.2017.08.022

    Article  PubMed  Google Scholar 

  30. Pisco JM, Bilhim T, Pinheiro LC et al (2016) Medium and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol 27(8):1115–1122. https://doi.org/10.1016/j.jvir.2016.04.001

    Article  PubMed  Google Scholar 

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Funding

There was no funding of this work.

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Authors and Affiliations

  1. Department of Urology, School of Medicine, University of St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Dominik Abt & Hans-Peter Schmid

  2. Department of Urology, Musgrove Park Hospital, Somerset Foundation Trust, Taunton, UK

    Mark J. Speakman

Authors
  1. Dominik Abt
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  2. Hans-Peter Schmid
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  3. Mark J. Speakman
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Contributions

DA: project development, literature review, manuscript writing and editing; H-P Schmid: project development, literature review, manuscript editing; MJS: project development, literature review, manuscript editing.

Corresponding author

Correspondence to Dominik Abt.

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Conflicts of interest

DA: Principle investigator and sub-investigator in several trials assessing LUTS/BPO treatments including prostatic artery embolization (PAE), HoLEP, Aquablation, laser vaporization, TURP, and iTIND. HPS: Sub-investigator in several studies on Prostatic artery embolization (PAE), HoLEP, Aquablation, laser vaporization, TURP. MJS: Member of the EAU LUTS/BPO guideline group, board member of the International Society for the Study and Exchange of evidence from Clinical research And Medical experience (ISSECAM). Sub-investigator for the ROPE study.

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Abt, D., Schmid, HP. & Speakman, M.J. Reasons to consider prostatic artery embolization. World J Urol 39, 2301–2306 (2021). https://doi.org/10.1007/s00345-021-03601-z

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  • DOI: https://doi.org/10.1007/s00345-021-03601-z

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