Abstract No. 455 Prostatic arterial embolization (PAE) for inoperable prostate cancer patients

Abstract

To retrospectively evaluate PAE for palliation of symptoms in prostate cancer (PCa) patients who are non-surgical candidates. This single-center retrospective review was conducted December 2013- September 2018 in 21 inoperable PCa patients (mean age 70±9 years). Superselective PAE was performed via radial or femoral access using cooling of collaterals technique with 300-500 μ Embospheres and cone-beam CT. Indications included hematuria (n=14), Urinary retention (n=4), Nocturia (n=1), bladder stones and lower urinary tract symptoms (n=1), and pre-radiation volume reduction (n=1). Nine patients were stage IV, three stage II, one stage I and eight stage Tx. Gleason scores ranged from 6-10. Bilateral PAE was achieved with technical success of 95% (20/21 patients). In one patient, left PAE was unsuccessful secondary to severe prostate artery stenosis. On average, complete hematuria control was achieved in 1.6 days (SD±1.5). The average duration of follow up was 402 days (SD±338). There were significant improvements in blood transfusion requirements, PSA levels, prostate size, and PCa symptoms. Blood transfusion requirements reduced by an average of 79% for all patients following PAE. Hemoglobin levels rose moderately by an average of 3.9% and PSA levels reduced significantly by an average of 81%. In one patient with stage 2b PCa referred for pre-radiation volume reduction, prostate volume improved from 139cc to 65.4cc (Δ52.9%) within two months of PAE. The average prostate reduction for all patients three months after PAE was 37.3%. One patient spontaneously voided his bladder calculi 48 hours after PAE. Four patients died during follow-up from PAE-unrelated etiologies without recurrence of symptoms. One patient developed acute urinary retention 9 months after PAE and was successfully managed conservatively. Another at 4 months developed recurrent hematuria, which improved with repeat PAE. None of the other patients developed recurrent symptoms. No complications were noted on follow-up. Our study indicates that PAE provides a clinically and statistically significant outcome for palliation of patients with inoperable PCa who are not candidates for curative resection.