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State of the art of prostatic arterial embolization (PAE)

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Posted 7/28/2019 12:52 PM (GMT 0)
If you are interested in finding out the options and complications of PAE, then you may wish to read this excellent and comprehensive paper:

Gland Surg. 2018 Apr;7(2):188-199. doi: 10.21037/gs.2018.03.01

State of the art of prostatic arterial embolization for benign prostatic hyperplasia.

Petrillo M1, Pesapane F1,2, Fumarola EM1,2, Emili I2, Acquasanta M2, Patella F1,2, Angileri SA1, Rossi UG3, Piacentini I4, Granata AM5, Ierardi AM1, Carrafiello G1.
Author information
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https://www.ncbi.nlm.nih.gov/pubmed/29770312

Abstract
Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). Several patients present contraindication for standard approach, individuals older than 60 years with urinary tract infection, strictures, post-operative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are not good candidates for surgery. Prostatic artery embolization (PAE) is emerging as a viable method for patients unsuitable for surgery. In this article, we report results about technical and clinical success and safety of the procedure to define the current status.

Post Edited (pamaf) : 7/29/2019 2:24:23 AM (GMT-6)

Posted 7/28/2019 1:01 PM (GMT 0)
This paper evaluates PAE for various prostate volumes:

Abstract
PURPOSE:
To determine the role of prostate volume as a predictor of outcome after prostatic artery embolization (PAE).
MATERIALS AND METHODS:
From January 2012 to September 2014, 78 consecutive patients undergoing PAE were evaluated at baseline and 1, 3, and 6 months. Analysis was performed comparing prostate volume groups (group 1, < 50 cm3; group 2, 50-80 cm(3); group 3, > 80 cm3) at baseline and follow-up to assess for differences in outcomes of American Urological Association (AUA) symptom index, quality of life (QOL)-related symptoms, and International Index of Erectile Function (IIEF).
RESULTS:
Mean baseline prostate volumes were 37.5 cm(3) in group 1 (n = 16), 65.7 cm3 in group 2 (n = 26), and 139.4 cm3 in group 3 (n = 36). There were no significant differences in baseline age, AUA symptom index, QOL, or IIEF between groups. Bilateral embolization was successful in 75 of 78 patients (96%). Two patients underwent unilateral embolization, and treatment failed in one patient as a result of bilateral atherosclerotic occlusion. A significant reduction in AUA symptom index was achieved within groups from baseline to 1, 3, and 6 months (n = 77): in group 1, from 27.2 to 14.0, 12.9, and 15.9, respectively (P = .002); in group 2, from 25.6 to 17.1, 16.3, and 13.5, respectively (P < .0001); and in group 3, from 26.5 to 15.2, 12.5, and 13.6, respectively (P < .0001). There was also a significant improvement in QOL. Comparative analysis demonstrated no statistically significant differences in AUA symptom index, QOL, or IIEF between groups. Two minor complications occurred: groin hematoma and a urinary tract infection.
CONCLUSIONS:
PAE offers similar clinical benefits to patients with differing gland sizes and may offer a reasonable alternative for poor candidates for urologic surgery.

Pasted from <https://www.ncbi.nlm.nih.gov/pubmed/26428880>
Posted 7/28/2019 1:06 PM (GMT 0)
This paper compares PAE vs open prostatectomy (OP)

Abstract
OBJECTIVE:
To evaluate 1-year surgical and functional results and morbidities of prostatic artery embolization (PAE) vs open prostatectomy (OP).
PATIENTS AND METHODS:
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) <4 ng/mL, or PSA between 4 and 10 ng/mL but negative prostate biopsy, total prostate volume >80 cm(3), and PF <15 mL/s. Follow-up was performed at 1 month, 6 months, and 1 year 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 1 year of follow-up.
RESULTS:
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 ≤15 mL/s (odds ratio, 4.95; 95% confidence interval, 1.73-14.15; P <.05) after 1 year.
CONCLUSION:
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

Pasted from <https://www.ncbi.nlm.nih.gov/pubmed/26199151>
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