Publications and Key Points on Prostate artery embolization
The literature on Prostatic Artery Embolization (PAE) comprises various types of studies, including prospective case series, small randomized controlled trials, and meta-analyses. These studies collectively provide insights into the effectiveness and safety of PAE as a treatment option for benign prostatic hyperplasia (BPH).
| Gao YA, Huang Y, Zhang R, et al. Benign prostatic hyper-plasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology 2014;270(3):920–928. | TURP had slightly shorter procedure time, greater initial improvement at 1 and 3 months and greater improvement in PSA values and prostate volume at all time points . PAE patients had more complications, primarily self-resolving postembolization syndrome and acute urinary retention. IPSS, quality-of-life score, Qmax rate, and PVR volume improved in both groups at 12 and 24 months. |
| Abt D, Hechelhammer L, Müllhaupt G, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 2018;361:k2338. | No significant difference in IPSS improvement between PAE (250–400-μm microspheres) and TURP at 12 weeks. TURP was more effective in improving Qmax rate, PVR volume, and prostate volume. Fewer adverse events, less blood loss, and shorter hospitalization occurred after PAE. Both groups had ejaculatory dysfunction. |
| Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, An-tunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Intervent Radiol 2016;39(1):44–52. | TURP and PERFECTED PAE groups had 100% clinical success (IPSS ≤8 and/or quality-of-life score ≤3). Standard PAE group had 87.6% clinical success and shorter hospitalization. IPSS post-treatment not significantly different between TURP and PERFECTED groups. TURP showed better mean prostate volume, quality of life, and Qmax rates but had more adverse events. |
| Bagla S, Smirniotopoulos J, Orlando J, Piechowiak R. Cost analysis of prostate artery embolization (PAE) and transure-thral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2017;40(11):1694–1697. | Compared 86 TURP patients with 70 PAE patients. - PAE showed significantly lower direct in-hospital costs and shorter hospital stays. |
| Russo GI, Kurbatov D, Sansalone S, et al. Prostatic arterial embolization vs open prostatectomy: a 1-year matched-pair analysis of functional outcomes and morbidities. Urology 2015;86(2):343–348. | Matched pairs of 80 patients in each group. - Prostatectomy group had lower IPSS, PVR volumes, and PSA levels, and greater Qmax rates at 1 year. PAE group had higher postoperative hemoglobin levels, lower hospitalization rates, and lower bladder catheterization rates. Higher rate of persistent symptoms at 1 year in PAE group. Overall complication rates were 31.25% for prostatectomy and 8.75% for PAE. |
| Ray AF, Powell J, Speakman MJ, et al. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int 2018;122(2):270–282. | PAE produced a median 10-point IPSS improvement, while TURP patients had a 15-point improvement. No noninferiority of PAE to TURP regarding IPSS and quality-of-life improvement in 65 propensity score–matched patients. PAE showed significant improvement in prostate volume and Qmax rates at 12 months. |
| Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol 2016;27(8):1115–1122. | Technical success: 98.1%. Mean procedure time: 77 minutes, fluoroscopy time: 19.5 minutes. Most patients (91.7%) discharged 3–6 hours post-procedure. Cumulative clinical success rates: 85.1% at 12 months, 81.9% at 30 months, 76.3% at 78 months. Common minor complications: dysuria (24.1%) and urinary frequency (23%). |
| Andrade G, Khoury HJ, Garzón WJ, et al. Radiation exposure of patients and interventional radiologists during prostatic artery embolization: a prospective single-operator study. J Vasc Interv Radiol 2017;28(4):517–521. | Study of 25 PAE patients reported an average fluoroscopy time of 30.9 minutes, mean dose-area product of 450.7 Gy·cm², mean peak skin dose of 2420.3 mGy, and average effective dose to the operator of 17 μSv. Higher doses were associated with procedures requiring longer fluoroscopy time. |
| Bilhim T, Pisco J, Campos Pinheiro L, et al. Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol 2013;24(11):1595–1602. | 100μm group: Greater decrease in PSA values. - 200μm group: Greater improvement in IPSS and quality-of-life score. |
| Gonçalves OM, Carnevale FC, Moreira AM, Antunes AA, Rodrigues VC, Srougi M. Comparative study using 100-300 versus 300-500 mm microspheres for symptomatic patients due to enlarged-BPH prostates. Cardiovasc Intervent Radiol 2016;39(10):1372–1378 | 100–300μm vs 300–500μm tris-acryl gelatin microspheres No significant differences in IPSS, quality-of-life score, prostate gland volume, PSA level, and Q max rate. |
| Bilhim T, Pisco J, Pereria JA, et al. Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. 2016;281(1):289-300 | Spherical vs. Non-spherical polyvinyl alcohol particles No difference in success rates at 12 months. Lower posttreatment IPSS correlated with a higher proportion of prostate ischemia measured at MRI. |
| Li Q, Duan F, Wang MQ, Zhang GD, Yuan K. Prostatic arterial embolization with small sized particles for the treat-ment of lower urinary tract symptoms due to large benign prostatic hyperplasia: preliminary results. Chin Med J (Engl) 2015;128(15):2072–2077 | Patients with prostate volume > 80 ml were treated with 50μm polyvinyl alcohol particles followed by 100μm particles. Mean reduction in prostate volume of 39.1% at 6 months. - Improvement in IPSS, quality of life, PVR volume, and Qmax rate. 83% of patients had sustained clinical success at 12 months. 32% required temporary bladder catheter placement for acute urinary retention 1–3 days after PAE. |
| Isaacson AJ, Raynor MC, Yu H, Burke CT. Prostatic artery embolization using Embosphere microspheres for prostates measuring 80-150 cm(3): early results from a US trial. J Vasc Interv Radiol 2016;27(5):709–714. | PAE is effective for prostates larger than 80 mL and in patients with acute urinary retention, with clinical success reported in 72.4%–98% of cases. No significant correlation found between prostate size and intermediate-term success. |
| Systemic reviews and Meta-analysis | |
| Uflacker A, Haskal ZJ, Bilhim T, Patrie J, Huber T, Pisco JM. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2016;27(11):1686–1697.e8. | Decrease in prostate volume: 31.31 mL Decrease in PVR volume: 85.54 mL Increase in Qmax rate: 5.39 mL/sec Improvement in IPSS: 20.39 points Improvement in quality-of-life score: 2.49 points at 12 months Transient urinary retention in 7.85% Rectalgia or dysuria in 9.1% - 0.3% serious adverse events |
| Feng S, Tian Y, Liu W, et al. Prostatic arterial embolization treating moderate-to-severe lower urinary tract symptoms related to benign prostate hyperplasia: a meta-analysis. Cardiovasc Intervent Radiol 2017;40(1):22–32. | Mean difference in IPSS: 13.25 points Mean difference in quality-of-life scores: 2.34 points Mean difference in PSA levels: 1.33 μg/mL Mean difference in prostate volumes: 28 mL Mean difference in Qmax rates: 5.51 mL/sec Mean difference in PVR volumes: 67.8 mL |
| Pyo JS, Cho WJ. Systematic review and meta-analysis of prostatic artery embolisation for lower urinary tract symp-toms related to benign prostatic hyperplasia. Clin Radiol 2017;72(1):16–22 | Mean improvement in IPSS: 14.06 at 3 months and 16.41 at 24 months Significant improvements in Qmax rates, PVR volumes, prostate volumes, PSA levels, and quality-of-life scores up to 12 months |
| Cizman Z, Isaacson A, Burke C. Short- to midterm safety and efficacy of prostatic artery embolization: a systematic review. J Vasc Interv Radiol 2016;27(10):1487–1493. | Improvement in IPSS: Not specified Improvement in quality-of-life scores: Not specified Increase in Qmax rates: 91% at 12 months Two hundred minor complications reported |
| Moreira AM, de Assis AM, Carnevale FC, Antunes AA, Srougi M, Cerri GG. A review of adverse events related to prostatic artery embolization for treatment of bladder outlet obstruction due to BPH. Cardiovasc Intervent Radiol 2017;40(10):1490–1500. | Nontarget embolization to the rectum during Prostatic Artery Embolization (PAE) can potentially lead to a condition called ischemic proctitis. This condition is characterized by symptoms such as pain, bloody diarrhea, or the formation of ulcers in the rectal area. Additionally, transient rectal bleeding has been reported in a range of 2.4% to 27% of cases. Furthermore, embolization of the penile arteries during PAE can result in ischemia, leading to symptoms like pain, skin redness (erythema), ulcer formation, or even sexual dysfunction. |