Prostate Artery Embolization Safe Option for Benign Hyperplasia

Kate Johnson

March 24, 2015

MADRID — Prostate artery embolization appears to be a safe and effective alternative to more traditional treatments for benign prostatic hyperplasia, according to two new studies.

"Although it's not going to replace surgery, it'll have a definite role," Bhaskar Somani, MD, from University Hospital in Southampton, United Kingdom, told Medscape Medical News.

It might be a stop-gap measure, especially for young men, until they need surgery. "The results are very good and very promising," said Dr Somani before he presented results from his team's study here at the European Association of Urology 30th Annual Congress.

"Prostate artery embolization is a feasible and minimally invasive technique," said Giorgio Ivan Russo, MD, from the University of Catania in Italy, who presented his team's study of the procedure.

However, the procedure is associated with persistent symptoms at 1 year and "should be performed in very select patients," Dr Russo added.

To date, no randomized direct comparison of prostate artery embolization and transurethral resection of the prostate has been completed; however, the new research provides short-term outcome data on artery embolization that can be compared with historic or current resection outcomes.

Prospective Studies

Dr Somani's team conducted the first prospective trial of prostate artery embolization in the United Kingdom. It involved 67 men (mean age, 66 years) with urodynamically proven outflow obstruction and a prostate volume greater than 40 cc who underwent embolization with local anesthesia.

In all cases, interventional radiologists performed the procedure, using a femoral arterial access approach, after prostatic CT and pelvic angiography planning.

"These patients are assessed by urologists and are counseled by urologists and radiologists together, but the actual procedure is done by interventional radiologists," Dr Somani explained.

International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), uroflowmetry results, and urodynamic test results were compared at baseline, and 3, 6, 12, 24, and 36 months after the procedure.

The technical success of the procedure was 100% for unilateral embolization and 80% for bilateral.

A 6 months, mean IPSS indicated an improvement in symptoms, mean prostate volume decreased by 45%, and mean IIEF was unchanged.

Table. Changes Over 6 Months

Mean Indicator Baseline 6 Months
Flow (mL/s) 7.4 11.2
Prostate volume (cc) 93.0 62.0
Prostate-specific antigen (ng/L) 5.2 3.8

 

There were no major complications, such as retrograde ejaculation, erectile dysfunction, or urinary tract infection. However, minor complications included mild self-limiting suprapubic and perineal pain, transient hematospermia, and small nonlimiting arterial dissection.

"At the short-term follow-up, the results were very good," said Dr Somani. "One-third of patients failed to have adequate symptom improvement and had chosen some other form of treatment by 12 months, but two-thirds of the patients did very well."

Dr Russo's team conducted a prospective matched-pair comparison of prostate artery embolization. Eighty consecutive patients treated at the Endocrinological Research Centre in Moscow were compared with 40 consecutive patients treated with open prostatectomy at Dr Russo's center in Italy.

Secondary end points were better with prostate artery embolization than with prostatectomy, including postoperative hemoglobin levels (14.4 vs 11.0 mg/dL; P < .05), days spent in the hospital (2 vs 9; P < .05), and days spent catheterized (0 vs 7; P < .05). However, the minimally invasive procedure had more long-term adverse effects.

On multivariate logistic regression, after adjustment for pre- and perioperative variables, "embolization was associated with persistent symptoms after 1 year," specifically for the primary end points of IPSS, IIEF, peak flow, postvoid residual urine, and IPSS quality of life, Dr Russo reported.

Compared with open prostatectomy, the odds ratio of an IPSS of at least 8 after embolization was 12.44 (confidence interval [CI], 5.50 - 12.89; P < .05) and of a peak flow of 15 mL/s or less was 4.95 (95% CI, 1.73 - 14.15; P < .05).

Safety Confirmed

Both studies show "that prostate artery embolization is effective, in terms of both subjective and objective outcomes, as a treatment option in benign prostatic hyperplasia. Moreover, the excellent safety profile of the procedure is confirmed," said Dominik Abt, MD, from Cantonal Hospital St. Gallen in Switzerland.

"However, data comparing embolization with transurethral resection of the prostate, which is still the surgical gold standard in the treatment of benign hyperplasia, is still lacking and highly warranted," he added.

Dr Abt is the principal investigator of an ongoing prospective randomized noninferiority trial comparing the two procedures (BMC Urol. 2014;14:94), which he hopes will further clarify the issue.

"The British study was not designed to directly compare the different treatment methods, and the study by Russo et al. had some major methodological limitations," he said.

Dr Somani, Dr Russo, and Dr Abt have disclosed no relevant financial relationships.

European Association of Urology (EAU) 30th Annual Congress: Abstracts 569 and 570. Presented March 22, 2015.

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