Prostatic Arterial Embolization vs Open Prostatectomy: A 1-Year Matched-pair Analysis of Functional Outcomes and Morbidities

Abstract

To evaluate 1-year surgical and functional results and morbidities of prostatic artery embolization (PAE) vs open prostatectomy (OP). We undertook 1:1 matched-pair analysis (International Prostate Symptom Score [IPSS], peak flow [PF], postvoid residual [PVR], and prostate volume) of 287 consecutive patients treated for benign prostatic obstruction, including 80 OP and 80 PAE. Inclusion criteria were as follows: lower urinary tract symptoms or benign prostatic obstruction, IPSS≥12, prostate-specific antigen (PSA)<4ng/mL, or PSA between 4 and 10ng/mL but negative prostate biopsy, total prostate volume >80cm(3), and PF<15mL/s. Follow-up was performed at 1month, 6months, and 1year at clinic. Primary end points of the study were the comparison regarding IPSS, International Index of Erectile Function-5, PF, PVR, and IPSS quality of life (IPSS-QoL) after 1year of follow-up. Regarding primary end points, OP group had lower IPSS (4.31 vs 10.40; P<.05), 1-year PVR (6.15 vs 18.38; P<.05), 1-year PSA (1.33 vs 2.12; P<.05), IPSS-QoL (0.73 vs 2.78; P<.05), International Index of Erectile Function-5 (10.88 vs 15.13; P<.05), and greater PF (23.82 vs 16.89; P<.01). The matched-pair comparison showed higher value of postoperative hemoglobin level (mg/dL) and shorter hospitalization (days) and catheterization (days) for PAE group. At the multivariate logistic regression, PAE was associated with persistent symptoms (IPSS≥8; odds ratio, 2.67; 95% confidence interval [CI], 0.96-7.4; P<.01) and persistent PF≤15mL/s (odds ratio, 4.95; 95% confidence interval, 1.73-14.15; P<.05) after 1year. PAE could be considered a feasible minimally invasive technique but failed to demonstrate superiority to OP because of the increased risk of persistent symptoms and low PF after 1year.