Clinical Case: Successful Use of Repeated Superselective Arterial Embolization in Metastatic Prostate Cancer Complicated by Bleeding

Abstract

Persistent hematuria, the source of which is a neoplasm of the prostate gland, is a potentially life threatening condition that exacerbates major therapeutic problems. The most common causes of severe hematuria are prostate cancer. Most often, severe recurrent prostatic bleeding occurs with untreated lesions and especially with hormone-refractory form of cancer. In many patients, bleeding cannot be completely controlled by conservative measures, such as routine hemostatic drugs, topical cold, urethral catheter drainage with permanent irrigation with sterile solutions, silver nitrate instillation, or endoscopic diathermy. Currently, the «gold standard» for the treatment of localized prostate cancer is radical prostatectomy. However, radical surgery is not always possible, despite the high efficiency, due to various circumstances, namely: age and due to this factor comorbidities that increase the risk of anesthesia. In this group of patients, it is advisable to use pelvic angiography with embolization, which proved to be a safe and effective method of controlling prostate bleeding. However, the analysis of the results of this technique is based on clinical cases and small, with a limited number of patients, studies. Despite this, selective arterial embolization has become the method of choice when conservative treatments are ineffective.