Embolization shows promise, wide applicability in BPH

Prostate artery embolization (PAE) may offer positive clinical benefits for up to 6 months in patients with varying degrees of BPH, recent study results suggest.

“Not only was it very successful, but it went above our expectations. We thought it would work in large and average-size prostates, but we didn’t think it would work across the board,” said lead investigator Sandeep Bagla, MD, of Inova Alexandria Hospital, Alexandria, VA.

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For the study, which was presented at the Society of Interventional Radiology annual scientific meeting in Atlanta, the authors looked at outcomes for 78 consecutive PAE patients who were treated between January 2011 and July 2014. They were categorized into three different analysis groups based on the size of the enlarged prostate (<50 cubic cm, between 50 and 80 cubic cm, and >80 cubic cm). The patients were assessed at 1, 3, and 6 months post treatment.

Dr. Bagla said PAE offers less risk, less pain, and less recovery time than traditional surgery. He noted that PAE is associated with a reduced risk of bleeding, urinary incontinence, or erectile dysfunction compared to some BPH therapies.

Among the 78 men treated, 75 cases were considered technically successful, with both blood vessels leading to the enlarged prostate blocked by PAE treatment. The authors found significant improvements in symptoms and quality of life in all three groups as measured by the AUA Symptom Index. There were no differences in outcomes among the three groups.

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No patients reported a change in their sexual function. Dr. Bagla attributes this low rate of side effects to the fact that PAE is conducted via the femoral artery versus other treatments, which enter through the urethra or penis.

“These patients were treated as part of their routine medical practice. It was not part of a trial. It is an alternative procedure for BPH. For it to be a device to be specifically approved for BPH, we are still a couple of years away from that,” Dr. Bagla said in an interview with Urology Times.

Next: How the procedure was performed

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In the procedure, interventional radiologists insert a catheter into the femoral artery and guide it to the prostate artery on both sides of the gland. Once positioned next to the prostate, microscopic spheres are delivered to block blood flow, causing the prostate to shrink. Dr. Bagla said the downside of this approach is that it is technically challenging and older men can have challenging anatomy because of their age.

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Dr. Bagla said interventional radiologists are specifically trained for this and so for them it is routine. In fewer than 5% of the cases, the arteries to the prostate are blocked so it may not be feasible, he noted. Another negative side to PAE is that it requires x-ray guidance, so the patient is exposed to radiation.

Gopal Gupta, MD, of Loyola University, Chicago, who was not involved in the study, said there are very few well-designed prospective trials to evaluate the efficacy of the treatment and many unanswered questions about its long-term benefits remain.

“Although the goal of devascularization of the prostate by PAE makes sense, there is still concern for durability and progression since the prostate will likely continue to grow unlike TURP [or] laser vaporization in which the prostate tissue is removed and patients have durable response rates of greater than 10 years,” Dr. Gupta told Urology Times.

“It is also unclear which patients would benefit from PAE upfront versus established BPH surgery. They tout the non-invasiveness of the procedure, but femoral artery catheterization is not without risks, including thrombotic events, pseudoaneurysm, bleeding, pain, etc. PAE needs to be studied further in randomized controlled trials before being offered to patients, in my opinion. The rates of incontinence and impotence and sexual dysfunction are very low in the modern TURP/PVP era.”

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