Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis

Abstract

Background To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). Methods A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. Results Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. Conclusion PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.

Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review

“…In 2022, Jung et al published a recent meta-analysis on both short-and long-term follow-up outcomes, concluding that the effects on urologic symptoms and patient-perceived improvements in quality of life seem to be comparable in the PAE and TURP group [37]. Our results confirm and are in agreement with previous studies reported in the literature [38][39][40].…”

“…Prostatic artery embolization has recently been represented as an alternative effective and safe treatment in male patients who cannot undergo TURP or for whom surgical therapies have been contraindicated, with a positive 5-year outcome: embolization of the gland can result in reduced volume without the need for surgical tissue removal. Despite the limitations, results of our systematic review agree with the latest meta-analyses on this topic [38][39][40]. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group.…”

Prostate Artery Embolization for Benign Prostatic Hyperplasia

“…11 The longest follow-up includes 2 years post RCT 6 and 10 years with large cohorts from highvolume centers. 12,13 These studies demonstrate that PAE provides a significant reduction in LUTS in the short to medium term 14 with an International Prostate Symptom Score reduction ranging from 9 to 21 points. 6,8 Functional outcomes, including maximum flow rate and postvoid residual, however, remain inferior to TURP due to the embolic rather than resective nature of PAE.…”

“…Nontarget embolization leading to bladder necrosis (<1%) or penile (<1%) or rectal ischemia (<5%) remains rare and can be managed conservatively. 14 Maintaining this safety profile and accurate embolization requires both experience and utilization of advanced image guidance in the form of cone-beam CT. Cone-beam CT provides 3-dimensional images of the prostatic and pelvic vasculature, providing more information than angiography alone, facilitating safety and efficacy. 2,16 Initial reports of safety are representative of the early understanding of expected PAE outcomes.…”

“…2,16 Following this paradigm, the adverse event profile favors PAE over invasive approaches, consisting of self-limited irritative voiding symptoms, hematospermia, and rare UTIs. 14 Limitations to PAE include a slower, gradual relief in symptoms when compared to TURP, and retreatment rates of up to 20% at 5 years. Other contraindications to PAE include LUTS secondary to etiologies other than BPH, treatment of small prostates, severe atherosclerosis, renal dysfunction, and severe contrast allergy.…”