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Semin intervent Radiol 2022; 39(06): 577-580
DOI: 10.1055/s-0042-1759732
Review Article

Long-Term PAE Results: What Do We Know

Tiago Bilhim
1   Saint Louis Hospital, Centro Hospitalar Universitário de Lisboa Central (CHULC) Lisbon, Portugal
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Abstract

Prostatic artery embolization (PAE) is a minimally invasive technique with proven safety and efficacy to treat lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) or benign prostatic hyperplasia (BPH). In this review, we discuss the required level of evidence to implement and adopt treatment options for patients with LUTS due to BPO/BPH. Focus is given on the long-term (>3 years) data after PAE with reported outcomes including cohort sizes, follow-up times, reintervention rates (repeat PAE and prostatectomy), need for LUTS/BPO medical therapy, and improvements in International Prostate Symptom Score/quality of life score, peak flow rate (Qmax), postvoid residual, prostate volume, and prostate-specific antigen. The durability of treatment effects after PAE and need for prostatic reinterventions need to be taken into consideration when discussing treatment options with patients and referring colleagues from other medical specialties. Developments in medical devices used for PAE have allowed for a continuous drop in unilateral PAE rates over the last 12 years and will probably play a role in optimizing technical and thus clinical outcomes for patients with LUTS due to BPH/BPO.

Keywords

long term - prostatic artery embolization - lower urinary tract symptoms - benign prostatic obstruction - benign prostatic hyperplasia - interventional radiology


Publication History

Article published online:
20 December 2022

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  • References

  • 1 Speakman MJ, Cornu JN, Gacci M. et al. What is the required certainty of evidence for the implementation of novel techniques for the treatment of benign prostatic obstruction?. Eur Urol Focus 2019; 5 (03) 351-356
    CrossrefPubMedGoogle Scholar
  • 2 Sun F, Sánchez FM, Crisóstomo V. et al. Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment – preliminary study in pigs. Radiology 2008; 246 (03) 783-789
    CrossrefPubMedGoogle Scholar
  • 3 Jeon GS, Won JH, Lee BM. et al. The effect of transarterial prostate embolization in hormone-induced benign prostatic hyperplasia in dogs: a pilot study. J Vasc Interv Radiol 2009; 20 (03) 384-390
    CrossrefPubMedGoogle Scholar
  • 4 Pisco JM, Bilhim T, Costa NV. et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol 2020; 77 (03) 354-362
    CrossrefPubMedGoogle Scholar
  • 5 Gao YA, Huang Y, Zhang R. et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate–a prospective, randomized, and controlled clinical trial. Radiology 2014; 270 (03) 920-928
    CrossrefPubMedGoogle Scholar
  • 6 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 (361) k2338
    CrossrefPubMedGoogle Scholar
  • 7 Insausti I, Sáez de Ocáriz A, Galbete A. et al. Randomized comparison of prostatic artery embolization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 2020; 31 (06) 882-890
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Malling B, Røder MA, Brasso K, Forman J, Taudorf M, Lönn L. Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol 2019; 29 (01) 287-298
    CrossrefPubMedGoogle Scholar
  • 10 Zumstein V, Betschart P, Vetterlein MW. et al. Prostatic artery embolization versus standard surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol Focus 2019; 5 (06) 1091-1100
    CrossrefPubMedGoogle Scholar
  • 11 Knight GM, Talwar A, Salem R, Mouli S. Systematic review and meta-analysis comparing prostatic artery embolization to gold standard transurethral resection of the prostate for benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2021; 44 (02) 183-193
    CrossrefPubMedGoogle Scholar
  • 12 Wu X, Zhou A, Heller M, Kohlbrenner R. Prostatic artery embolization versus transurethral resection of the prostate for benign prostatic hyperplasia: a cost-effectiveness analysis. J Vasc Interv Radiol 2022; S1051-0443 (22)01127-7
    PubMedGoogle Scholar
  • 13 Rink JS, Froelich MF, McWilliams JP. et al. Prostatic artery embolization for treatment of lower urinary tract symptoms: a Markov model-based cost-effectiveness analysis. J Am Coll Radiol 2022; 19 (06) 733-743
    CrossrefPubMedGoogle Scholar
  • 14 Abt D, Müllhaupt G, Hechelhammer L. et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic hyperplasia: 2-yr outcomes of a randomised, open-label. Eur Urol 2021; 80 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 15 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 (02) 270-282
    CrossrefPubMedGoogle Scholar
  • 16 Lin YT, Pereira H, Pellerin O, Déan C, Thiounn N, Sapoval M. Four-year impact of voiding and storage symptoms in patients with benign prostatic hyperplasia treated with prostatic artery embolization. J Vasc Interv Radiol 2020; 31 (09) 1460-1466
    CrossrefPubMedGoogle Scholar
  • 17 Carnevale FC, Moreira AM, de Assis AM. et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years' experience. Radiology 2020; 296 (02) 444-451
    CrossrefPubMedGoogle Scholar
  • 18 Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E. Long-term outcome of prostatic artery embolization for patients with benign prostatic hyperplasia: single-centre retrospective study in 1072 patients over a 10-year period. Cardiovasc Intervent Radiol 2022; 45 (09) 1324-1336
    CrossrefPubMedGoogle Scholar
  • 19 Xu ZW, Zhou CG, Tian W, Shi HB, Liu S. Long-term efficacy and recurrence prediction of prostatic artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2022; DOI: 10.1007/s00270-022-03272-2.
    CrossrefPubMedGoogle Scholar
  • 20 Bilhim T, Betschart P, Lyatoshinsky P, Müllhaupt G, Abt D. Minimally invasive therapies for benign prostatic obstruction: a review of currently available techniques including prostatic artery embolization, water vapor thermal therapy, prostatic urethral lift, temporary implantable nitinol device and aquablation. Cardiovasc Intervent Radiol 2022; 45 (04) 415-424
    CrossrefPubMedGoogle Scholar