Prostatic Artery Embolization For Treatment Research Articles

Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms: A Markov Model-Based Cost-Effectiveness Analysis.

The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP). The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature. A decision tree-based Markov model was created, analyzing long-term cost-effectiveness for TURP and PAE from a US health care sector perspective. Cost-effectiveness over a time frame of 5 years was estimated while assuming a willingness to pay of $50,000 per quality-adjusted life-year (QALY). The primary outcome was incremental cost-effectiveness ratio. PAE resulted in overall cost of $6,464.92 and an expected outcome of 4.566 QALYs. In comparison, TURP cost $9,221.09 and resulted in expected outcome of 4.577 QALYs per treatment. The incremental cost-effectiveness ratio for TURP was $247,732.65 per QALY. On the basis of the willingness-to-pay threshold, PAE is cost effective compared with TURP. On the basis of our model, PAE in comparison with TURP can be regarded as a cost-effective treatment option for patients with lower urinary tract symptoms within the US health care system.

Anatomical variants in prostatic artery embolization in treatment of benign prostatic hyperplasia

BackgroundBenign prostatic hyperplasia (BPH) is the most prevalent benign tumor in aged men, and its prevalence is rising with age reaching 8% in the fourth decade of life and up to 90% in the ninth decade. PAE has long been considered as a safe and effective minimally invasive therapy option for individuals with moderate to severe lower urinary tract symptoms caused by prostatic hypertrophy. Because of the varying degrees of atherosclerosis seen in the elderly, PAE is generally a difficult treatment that necessitates a particular amount of knowledge of anatomy and a specific set of abilities. It is critical to emphasize anatomical information about PA that is required for a successful PAE, as well as radiation exposure factors that can be helpful in such a protracted treatment. This thesis provides a pictorial review of PA anatomy and prevalence of related anatomical variants, besides additional anatomical and radiation dosage concerns, and knows the important effect of the anastomosis on non-target embolization as in our study we included large number of cases (83 patients) to cover all types of variations and different types of anastomosis all were covered.ResultsA total of 83 patients (166 sides) were analyzed. Double arterial supply on the same side was noted in 1 patient (1.2%). In 3 patients (3.6%), only a unilateral PA was identified. PA origin frequencies were computed. Penile, rectal, vesical anastomoses, and anastomosis with the other side were identified with 7 (8.4%), 3 (3.6%), 2 (2.4%), and 8 (9.6%) of PAs, respectively. Mean skin radiation dose was 479 mGy.ConclusionsWhen treating BPH with PAE, understanding PA anatomy is critical for achieving the best results. The anatomy of the PA is critical for preventing non-target embolization and is directly related to the correct identification of the anatomical pattern of the prostate arteries, and we should also take into account the presence of contralateral anastomoses; it is possible to achieve both prostate lobes through catheterization of the prostatic artery on only one side.

Abstract No. 529 Influence of body mass index on patient radiation exposure in prostate artery embolization for treatment of benign prostatic hyperplasia

While prostate artery embolization (PAE) is an option for the treatment of benign prostatic hyperplasia (BPH), factors such as body mass index (BMI) may lead to excessive radiation doses during the procedure or increased failure rates. This study will aim to determine how BMI impacts radiation exposure, success rates of PAE and prostate size. Additionally, this study will determine if a cut-off BMI should be implemented for patients opting for therapy via PAE in an outpatient-based laboratory using a mobile fluoroscopy unit.

Prostate Arterial Anatomy: A Primer for Interventional Radiologists

Identification of the prostatic arteries (PAs) is one of the most challenging aspects of prostate artery embolization for treatment of benign prostatic hyperplasia-associated lower urinary tract symptoms. Operators require a detailed understanding of the prostate arterial anatomy to ensure technical and clinical success with minimal complications. Due to substantial variability in internal iliac artery branch patterns and specifically the origin of the PA, we focus on 3 clinically relevant classification systems used to categorize the pelvic vasculature. These include classification systems to understand the internal iliac artery branching pattern, PA origin variation, and intraprostatic branching.

Prostatic Artery Embolization for Treatment of Symptomatic Benign Prostatic Hyperplasia Patients: Short- and Intermediate- term Outcome

Background: Benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and is the most common cause of lower urinary tract symptoms (LUTS). There are several treatment options for benign prostatic hyperplasia. Aim: This study aims to evaluate the effectiveness, safety, morbidity and short- and intermediate-term results of prostatic artery embolization (PAE) for symptomatic BPH patients with moderate to severe LUTS. Methods: A prospective cohort study was carried out on 33 BPH patients, with moderate to severe LUTS. PAE was performed for patients and they were followed up at 3, 6 and 12 months post-procedural. Results and conclusion: Post-embolization follow-up results revealed significant reduction in the mean prostatic volume, post-voiding residual urine volume, severity of symptoms , total prostate specific antigen (PSA) level as well as significant improvement in patients’ quality of life (QoL). Meanwhile, no statistically significant changes were found in the erectile function post-procedural. Future researchers are recommended to replicate this study with longer follow-up periods, especially multi-center randomized controlled trials, using different types of embolic agents.

3:18 PM Abstract No. 64 Efficacy of prostatic artery embolization for treatment of lower urinary tract symptoms from benign prostatic hyperplasia in the setting of non-obstructive localized prostate cancer

The purpose of this study is to assess clinical outcomes of prostatic artery embolization (PAE) in men with localized prostate cancer (PCa) and lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH). From January 2017 to August 2019, 44 men underwent PAE for LUTS. 10 men (mean age, 70.7; range, 48-85; mean PSA, 13; range, 0.5-37.7; mean Gleason score, 7.3; range, 6-9; 8 undergoing ADT) underwent PAE for LUTS in the setting of non-obstructive PCa. Retrospective review of medical records and imaging studies was performed in order to assess International Prostate Symptom Score (IPSS) (n = 6) and quality of life (QoL) (n = 6) at 12 weeks, cross-sectional prostate volume at 6 weeks (n = 8) and at 12 weeks (n = 6), PSA at 12 weeks (n = 5), and imaging disease progression at 12 weeks (n = 5). PAE was technically successful in all patients. No SIR grade moderate or higher adverse effects were seen. One patient experienced mild adverse effect of bladder spasm. IPSS and QoL at 12 weeks improved by a mean of 11.67 (range, 1-25) and 2.33 (range, 1-24) points, respectively. Mean prostate volume reduction at 6 weeks and 12 weeks was 24.5% (range, 7.2-36.7) and 22.4% (range, -17.9-44), respectively. PSA decreased by average 47% at 12 weeks (range, 1.7-93.3). On 12-week MRI, no lesions increased in PIRADS score, 3 lesions decreased by at least 1 point and no extraprostatic disease progression was seen. All patients completed definitive therapy successfully with prostatectomy (n = 1) or radiation therapy (n = 9). PAE for men with LUTS from BPH and non-obstructive PCa results in clinical improvement without increased side effects of non-target embolization or disease progression. PAE is safe and effective for men with LUTS from BPH in the setting of non-obstructive PCa.

4:12 PM Abstract No. 70 Prostatic artery embolization for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a single-center experience with 2-year follow-up

Prostate artery embolization (PAE) has emerged as an effective and favorable procedure for treatment lower urinary tract symptoms (LUTS) in patients with BPH. This study evaluates the efficacy of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). 256 patients who underwent PAE for either BPH with LUTS, hematuria, urinary retention or a combination of these from January 2014 to May 2019 were evaluated as part of an IRB-approved retrospective analysis at a single institution. Patients with active urinary tract infection (UTI), renal failure, urinary retention severe atherosclerosis were excluded from the analysis. Mean patient age was 68.2 years, mean prostate volume was 118.4 g, mean pre procedure IPSS, QOL, SHIM were 23.6, 4.7, and 15.4, respectively. Patients were evaluated at 1, 3, 6, 12, 24-month intervals following PAE. Adverse events were recorded using the Clavien-Dindo classification. Three months after PAE, mean IPSS decreased from 23.6 to 8.3 (↓65%, n = 213, P <0.001) and mean QOL improved from 4.7 to 1.5 (↓68%, n = 217, P <0.001). Twelve months after PAE, mean IPSS was 7.8 (↓6%, n = 122, P <0.001), mean QOL was 1.4 (↓ 7%, n = 121, P <0.001) and prostate size decreased from 116 g to 76 g (↓34%, n = 61, P <0.001). At 24 months, mean IPSS and QOL were 11.1 and 2.1 (↑42%, ↑50%, from 6 months, n = 11, P <0.001). Three patients required a second PAE procedure. 41% of patients had a grade I event, 7% had a grade II event and 0.1% had a grade IV event. PAE has been established as a clinically efficacious procedure for patients with BPH. Patients have reported promising long-term outcomes, including maintained relief of LUTS and significant improvement in quality of life.

4:03 PM Abstract No. 69 Prostatic artery embolization for treatment of hematuria of prostatic origin: a single-center analysis

To expand upon the efficacy of prostate artery embolization (PAE) for the treatment of refractory hematuria. 82 patients who underwent PAE for treatment of intractable hematuria (IH) or recurrent hematuria (RH) (n = 45, n = 37) from December 2013 to May 2019 were evaluated as part of a retrospective analysis at a single institution. The primary endpoint was days to cessation of hematuria following PAE. Pre- and post procedure hemoglobin (Hgb), number of blood transfusions, and prostate volume were recorded. Patients without active hematuria in the preoperative time frame were excluded. Adverse events were recorded using the Clavien-Dindo classification. PAE was technically successful in all cases. In the IH cohort, etiology was secondary to benign prostatic hyperplasia (BPH) in 17, prostate carcinoma in 12, urologic instrumentation in 10, and bladder carcinoma in 6. In the RH cohort, etiology was secondary to BPH in 28 and prostate carcinoma in 9. Hematuria cessation was achieved in 1.7 ± 1.7 days in the IH cohort and 1.5 ± 2.5 days in the RH cohort following PAE. In the IH cohort Hgb levels increased from 8.2 g/dl to 9.8 g/dl (↑20%, P <0.001), number of blood transfusions decreased from 3.4 units to 0.8 units (↓76%, P <0.001), and prostate volume decreased from 160.4 g to 77.5 g (↓52%, P = 0.002). In the RH cohort Hgb levels increased from 11.5 g/dl to 12.2 g/dl (↑6% P = 0.01), number of blood transfusions decreased from 0.36 units to 0.12 units (↓67% P = 0.02), and prostate volume decreased from 161 g to 80.5 g (↓50% P = 0.01). 24% of patients had grade I events, 1 grade II event occurred. PAE offered a quick resolution to IH and RH. Additional significant benefits included increased Hgb levels, decreased requirement of blood transfusions, and decreased prostate size. Therefore, PAE represents an effective modality to treat refractory hematuria of prostatic origin.

Case-Control Comparison of Conventional End-Hole versus Balloon-Occlusion Microcatheter Prostatic Artery Embolization for Treatment of Symptomatic Benign Prostatic Hyperplasia.

To compare procedural metrics and clinical improvement for prostatic artery embolization (PAE) performed with a balloon-occlusion (BO) versus end-hole (EH) microcatheter in patients with benign prostatic hyperplasia. Retrospective review was performed of 129 patients undergoing PAE with 100-300 μm Embosphere microspheres from April 2013 through August 2018. Microcatheter selection was nonrandom, based on prostatic artery anatomy. Five technical failures and 5 microcatheter crossover cases were excluded. BO group (n= 46, age 72.8 y ± 9.0, gland volume 184 mL ± 83, 42% in retention) and EH group (n= 73, age 76.0 y ± 9.0, gland volume 190 mL ± 116, 44% in retention) were compared using procedural metrics (excluding 30 EH learning-curve cases); symptomatic improvement at 3, 6, and 12 months after PAE; voiding trial success; and adverse events (reported used Clavien-Dindo classification). Procedural and fluoroscopy times were lower in the BO group (n= 46) vs EH group (n= 43) (152.0 min ± 34.0 vs 172.8 min ± 47.9, P < .02; 37.8 min ± 12.9 vs 50.3 min ± 18.9, P < .001). Collaterals coiled, contrast material used, and injected particle volume were similar for both groups (P= NS). International Prostate Symptom Score improvement was similar for BO group (n= 25) (before PAE 23.5 ± 6.5, 12 months after PAE 7.6 ± 6.8) and EH group (n= 30) (before PAE 20.9 ± 5.9, 12 months after PAE 6.6 ± 5.2) (P= NS). Quality-of-life improvements were also similar (BO: before PAE 4.5 ± 1.2, 12 months after PAE 1.4 ± 0.9; EH: before PAE 4.1 ± 1.0, 12 months after PAE 0.9 ± 0.7), as were 12-month postvoid residual improvements, voiding trial failure rates (EH 12%, BO 8%), and adverse event rates (grade II, III: EH 15%, BO 11%) (P= NS for all). BO microcatheter use in PAE did not affect injected particle volume, contrast material use, or protective coiling and did not impact symptomatic improvement, postvoid residual improvement, voiding trial success, or adverse events after PAE. Lower procedure and fluoroscopy times with BO microcatheter were likely due to selection bias.

Impact of 5-Alpha-Reductase Inhibitors Use at the Time of Prostatic Artery Embolization for Treatment of Benign Prostatic Obstruction

PurposeTo compare the 12-month post-prostatic artery embolization (PAE) clinical outcomes of patients who were and were not taking 5-alpha-reductase inhibitors (5ARIs) at the time of PAE. Materials and MethodsA retrospective review was conducted of patients who underwent PAE from 2010 to 2017 due to lower urinary tract symptoms, secondary to benign prostatic hyperplasia (BPH). One hundred fifty-five patients were included and divided in 2 groups; these groups did not present statistically significant differences in their baseline characteristics—those taking 5ARIs (Y-5ARIs, n = 40) and those not taking 5ARIs (N-5ARIs, n = 115). International Prostate Symptom Score (IPSS), the sub-item Quality of Life (QoL), and the incidence of clinical failure were used as primary endpoints. Secondary endpoints included mean prostate volume reduction and mean peak flow rate (Qmax) improvement. Clinical failure or recurrence was defined as absence of symptomatic improvement (IPSS ≥ 8 or QoL ≥ 3) or the need for invasive BPH treatment (PAE or transurethral resection of the prostate) during the 12-month follow-up period. ResultsAfter 12-month follow-up, IPSS, QoL, and prostatic volume were significantly lower compared to baseline in both groups, and Qmax showed a significant increase. No statistically significant differences were observed in outcomes between N-5ARIs and Y-5ARIs, and the clinical failure rate for both groups was approximately 20%. ConclusionsThe use of 5ARIs did not show a detrimental effect on clinical outcomes of PAE, in either subjective (IPSS, QoL, and clinical failure) or objective (prostatic volume and Qmax) parameters.

Utility of MR Angiography in the Identification of Prostatic Artery Origin Prior to Prostatic Artery Embolization

In 17 patients who underwent prostate artery embolization for treatment of lower urinary tract symptoms, the accuracy of preprocedural magnetic resonance (MR) angiography was retrospectively compared with intraprocedural digital subtraction angiography (DSA) in the identification of prostatic artery origin. Of 34 vessels, 26 MR angiography identified origins (76.5%) were confirmed by DSA at the time of embolization. Although image postprocessing is required, the ability of MR angiography to accurately identify prostatic artery origins prior to embolization is useful in treatment planning and can obviate the need for separate computed tomographic angiography, thus reducing both radiation dose and time demand on patients.

A Review of Adverse Events Related to Prostatic Artery Embolization for Treatment of Bladder Outlet Obstruction Due to BPH

Minimally invasive procedures have gained great importance among the treatments for benign prostate hyperplasia (BPH) due to their low morbidity. Prostate artery embolization has emerged as a safe and effective alternative for patients with large volume BPH, not suited for surgery. Low adverse events rates have been reported following prostate artery embolization and may include dysuria, urinary infection, hematuria, hematospermia, acute urinary retention and rectal bleeding. Although most complaints are reported as side effects, complications can also be superimposed. The prostate gland is the most common source of complaints following PAE, where the inflammatory process can create a large variety of localized symptoms. Periprostatic organs and structures such as bladder, rectum, penis, seminal vesicle, pelvis, bones and skin may be damaged by nontarget embolization, especially due to the misidentification of the normal vascular anatomy and variants or due to inadvertent embolic reflux. Radiodermatitis may also happen in case of small vessel size, atherosclerosis, the learning curve and long procedure or fluoroscopy times. Regarding safety, it is pivotal to understand the pathophysiology of adverse events following PAE and their standardized reporting. The aim of this article is to discuss adverse events, their management and to review the current literature.

Prostatic Artery Embolization for Treatment of Benign Prostatic Hyperplasia in Patients with Prostates > 90 g: A Prospective Single-Center Study

PurposeTo describe the safety and efficacy of prostatic artery embolization (PAE) with spherical microparticles to treat lower urinary tract symptoms associated with benign prostatic hyperplasia in patients with prostate volume > 90 g. Materials and MethodsThis prospective, single-center, single-arm study was conducted in 35 patients with prostate volumes ranging from 90–252 g. Mean patient age was 64.8 years (range, 53–77 y). Magnetic resonance imaging, uroflowmetry, and the International Prostate Symptom Score (IPSS) were used to assess clinical and functional outcomes. ResultsMean prostate size decreased significantly from 135.1 g before PAE to 91.9 g at 3 months of follow-up (P < .0001). Mean IPSS and quality-of-life index improved from 18.3 to 2.7 and 4.8 to 0.9 (P < .0001 for both), respectively. A significant negative correlation was observed between prostate-specific antigen at 24 hours after PAE and IPSS 3 months after PAE (P = .0057). ConclusionsPAE is a safe and effective treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia in patients with prostate volume > 90 g. Excessively elevated prostate-specific antigen within 24 hours of PAE is associated with lower symptom burden in short-term follow-up.

MRI findings after prostatic artery embolization for treatment of benign hyperplasia.

The purpose of this article is to assess and describe the MRI findings after prostatic artery embolization for treatment of benign prostatic hyperplasia. We retrospectively evaluated 17 patients who underwent prostatic artery embolization as part of different prospective studies to evaluate this alternative treatment of benign prostatic hyperplasia. Clinical results were evaluated by assessment of urinary catheterization and International Prostate Symptom Score (IPSS). Serial MRI examinations were performed, and the prostatic central gland and peripheral zone were evaluated for signal intensity changes and the presence and characteristics of infarcted areas. Statistical analysis was performed with ANOVA for repeated measures and Student t test. All patients had clinical success, as defined by the removal of indwelling urinary catheter or decreased IPSS after embolization. Infarcts were seen in 70.6% of the subjects, exclusively in the central gland, were almost always characterized by hyperintensity on T1-weighted images and predominant hypointensity on T2-weighted images, and became smaller (mean reduction, p < 0.001) and isointense to the remaining of the central gland over time. Volume reduction of the prostate after embolization was significant (averaging 32.0% after 12-18 months; p < 0.001) only in patients with infarcts. No statistically significant association was seen between the development of infarcts and IPSS. MRI can be used for assessing the development of infarcts and volume reduction in the prostate after embolization. Further studies are needed to correlate these findings to clinical outcome.