Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

Knight, Gabriel; Talwar, Abhinav; Salem, Riad; Mouli, S.

doi:10.1007/s00270-020-02657-5

Cited by 52 publications

(38 citation statements)

References 28 publications

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“…Xu et al ( 30 ) and Zumstein et al ( 31 ) showed that amelioration of IPSS and QoL were better in TURP than in PAE. Gabriel et al ( 32 ) and Xiang et al ( 33 ) reported significant differences between PAE and TURP for Qmax, prostate volume, and PSA. However, Jiang et al ( 34 ) revealed that amelioration of IPSS was similar and amelioration of QoL was better in PAE than in TURP.…”

Section: Discussionmentioning

confidence: 99%

An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Cai

et al. 2021

Front. Surg.

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Background: Prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH) has been introduced into clinical practice, but conclusive evidence of efficacy and safety has been lacking.Objective: To compare the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of prostate (TURP), we performed a meta-analysis of clinical trials.Methods: We searched randomized controlled trials (RCTs) from Pubmed, Embase, Wanfang, and CNKI from January 2000 to December 2020 and used RevMan 5.0 to analyze the data after five RCTs were included.Results: The reducing of prostate volume (PV) [Median mean (MD) 14.87; 95% confidence interval (CI) 7.52–22.22; P < 0.0001] and the increasing of maximum flow rate in free uroflowmetry (Qmax) (MD 3.73; 95% CI 0.19–7.27; P = 0.004) were more obvious in TURP than in PAE; however, the rate of lower sexual dysfunction [odds ratio (OR) 0.12; 95% CI 0.05–0.30; P < 0.00001] was lower in PAE compared with TURP. Meanwhile, no conspicuous difference in International Prostate Symptoms Score (IPSS) score (MD 1.42; 95% CI −0.92 to 3.75; P = 0.23), quality of life (Qol) score (MD 0.21; 95% CI −0.31 to 0.73; P = 0.43), post void residual (PVR) (MD 21.16; 95% CI −5.58 to 47.89; P = 0.12), prostate-specific antigen (PSA) (MD 0.56; 95% CI −0.15 to 1.27; P = 0.12), and complications (OR 0.90; 95% CI 0.20–4.05; P = 0.89) between PAE and TURP group was shown.Conclusion: PAE may replace TURP as an alternative treatment for Benign prostatic hyperplasia (BPH) patients who do not want to have surgery or with operational contraindications.

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Section: Discussionmentioning

confidence: 99%

An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Cai

et al. 2021

Front. Surg.

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“…More recently, a systematic review analyzed six trials comparing PAE with transurethral resection of the prostate (TURP) in 598 patients. 32 33 34 35 36 37 TURP provided a significantly higher increase of the Qmax (mean difference of 5.02 mL/s), greater prostate volume reduction (mean difference = 15.59 mL) and greater PSA reduction (mean difference = 1.02 ng/mL). No significant differences between PAE and TURP were noted for the IPSS/QoL scores, IIEF-5 scores and PVR.…”

Section: Level Of Evidencementioning

confidence: 96%

Prostatic Artery Embolization for Benign Prostatic Hyperplasia—A Primer for Interventional Radiologists

Bilhim

Costa

Torres

2021

The Arab Journal of Interventional Radiology

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Male patients over 50 years with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are potential candidates for prostatic artery embolization (PAE). PAE is not a perfect fit for all BPH patients. Careful pre- and postpostprocedural evaluation/consultation with correct selection of patients should be tailored on an individual basis. Evaluated parameters include the following: LUTS severity quantification with validated questionnaires as the international prostate symptom score (IPSS) and quality of life (QoL), erectile and ejaculatory evaluation with validated questionnaires, blood tests including full blood count, coagulation profile, renal function and total/free prostate-specific antigen (PSA), prostate volume measured by multiparametric magnetic resonance (mpMR) of the prostate and/or transrectal ultrasound, uroflowmetry measuring the peak urinary flowrate (Qmax), and postvoid residual urine (PVR). Correct arterial anatomy identification with either computed tomography (CT) angiography, MR angiography, or intraprocedural cone-beam CT (CBCT) are suggested for a confident procedure and avoiding potential complications. The minimally invasive nature of PAE with a faster recovery, preserving the sexual function, and comparable results to standard prostatic surgery make the procedure an attractive choice for many male patients suffering with this condition. Patients should be informed about the potential for higher retreatment rates and shorter duration of treatment effect when compared with standard prostatic surgery. In this comprehensive review, we provide an updated toolbox for all interventional radiologists interested in the PAE practice for patients with BPH. We explain how to evaluate patients during consultation before and after PAE, describe the preprocedural imaging required, explain the technique, and narrate how to optimize outcomes. Finally, we review the level of evidence of PAE for BPH.

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“…But to answer this question, we also need to know the profile of our treatment options. As confirmed in the review by Knight et al [1], we can consider PAE as safe and effective in the short to mid-term, while additional data regarding long-term outcomes ([ 36 months), re-treatment rates and optimum patient selection would still be helpful to improve individual patient counselling.…”

mentioning

confidence: 87%

“…We would like to congratulate the authors for their efforts in comparing safety and efficacy of PAE and TURP and for adhering to current standards for systematic reviews and meta-analyses (PRISMA) [1]. There are two main differences compared to our own meta-analysis published previously [2].…”

mentioning

confidence: 99%

Commentary on the Article “Systematic Review and Meta-Analysis Comparing Prostatic Artery Embolisation to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia”

Abt

Zumstein

2020

Cardiovasc Intervent Radiol

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Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

Cited by 52 publications

References 28 publications

An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Prostatic Artery Embolization for Benign Prostatic Hyperplasia—A Primer for Interventional Radiologists

Commentary on the Article “Systematic Review and Meta-Analysis Comparing Prostatic Artery Embolisation to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia”

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