Abstract
ObjectiveTo describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate.Materials and MethodsThis was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms.ResultsThe PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment.ConclusionIn patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.
Highlights
As the average age of the population continues to rise, mainly because of better living conditions—including improved health care, healthier nutrition, and early disease detection—physicians are facing aging-related conditions, including benign prostatic hyperplasia (BPH), with everincreasing frequency
BPH can lead to a pronounced increase in prostate volume, resulting in a condition known as giant prostatic hyperplasia[4,5]
At 3 months after prostatic artery embolization (PAE), the International Prostate Symptom Score (IPSS) showed an 81.3% reduction when compared with the baseline value (2.9 ± 2.8 vs. 15.73 ± 4.2; p = 0.001)
Summary
As the average age of the population continues to rise, mainly because of better living conditions—including improved health care, healthier nutrition, and early disease detection—physicians are facing aging-related conditions, including benign prostatic hyperplasia (BPH), with everincreasing frequency. An enlarged prostate is common in men over 50 years of age and may or may not be accompanied by deleterious lower urinary tract symptoms (LUTS). Assis AM et al / PAE for giant prostatic hyperplasia for quite some time, and the volume of the prostate can increase significantly before appropriate treatment is given. The aromatase enzyme that mediates the production of estrogens from testosterone[3] could explain why testosterone levels in men drop by about 35% between the ages of 21 and 85, while estradiol levels either remain constant or increase. BPH can lead to a pronounced increase in prostate volume, resulting in a condition known as giant prostatic hyperplasia[4,5]
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