The First 48 Consecutive Patients with 3-Year Symptom Score Follow-Up Post-Prostate Artery Embolization (PAE) at a Single-Centre University Hospital

Maclean, Drew; Harris, Mark; Long, Joe; Modi, Sachin; Bryant, Tim; Hacking, Nigel

doi:10.1007/s00270-019-02381-9

Cited by 8 publications

(11 citation statements)

References 20 publications

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“…Published data have demonstrated PAE effectiveness in significantly reducing PV by between 20% and 40% in enlarged prostates, without the associated risks of traditional surgery. 9,10,[17][18][19] The PV, uroflometry, and patient-related outcomes (IPSS, QoL index, and IIEF-5 score) from this study are in line with the results of previous publications. Prostate artery embolization may also be technically less challenging in patients with very large prostates as the prostate arteries themselves become more hypertrophied and therefore potentially easier to cannulate; PAE is therefore beneficial for significantly enlarged prostate glands (>80 mL) for which the current CUA recommendation is open simple prostatectomy.…”

Section: Discussionsupporting

confidence: 90%

“…16 It has been proposed as a minimally invasive option for patients with BPH, with favorable results from numerous trials published worldwide in the last 5 years. 9,10,12,[17][18][19] Indeed, PAE has gained approval from the National Institute for Clinical Excellence in the United Kingdom as a standard of care treatment for men with symptomatic BPH. 20 Pisco et al performed the first randomized control trial comparing PAE to a sham procedure; results clearly demonstrated superior efficacy of PAE in comparison with the sham procedure, providing level I evidence for its utility in treating BPH.…”

Section: Discussionmentioning

confidence: 99%

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Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes

et al. 2020

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Introduction: This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH). Methods: A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Qmax) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines. Results: Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% ( P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure ( P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Qmax (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure ( P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B). Conclusion: Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes

et al. 2020

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“…Appropriate patient selection for prostatic artery embolization is crucial, but there is a lack on reliable predictors for the clinical outcome after PAE. It is still a matter of discussion if volume reduction correlates with the clinical improvement in terms of a reduction in LUTS measured by different scores [8, 14,21,27,28]. This study showed that all MRI BPH pattern had similar outcome in IPSS and volume reduction.…”

Section: Discussionmentioning

confidence: 72%

“…Nevertheless, there is still uncertainty about possible predictors to estimate the clinical outcome after therapy [8][9][10][11][12][13]. As a preinterventional factor, baseline volume could have an impact on both size reduction as well as symptom severity [8, [14][15][16][17]. However, Bagla et al did not report on this relationship [18].…”

Section: Introductionmentioning

confidence: 99%

Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization

Boschheidgen

Al-Monajjed

Minko

et al. 2023

Preprint

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Background To investigate the influence of MRI hyperplasia patterns in benign prostate hyperplasia (BPH) and tissue composition on outcome parameters in a collective of patients undergoing prostate artery embolization (PAE). Materials & Methods This retrospective study included patients (median age 72y) with the diagnosis of BPH, who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). Lower urinary tract symptoms (LUTS) were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome. Results For clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41 - 75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion and prostatic urethra angle in our collective (p<0.01). Median volume reduction was 25% (IQR 15% - 34%). Multiple linear regression model showed significant effect of high initial volume on reduction in IPSS scores after treatment (p<0.01). Presence of AdBPH was significantly associated with both volume loss and clinical improvement in terms of IPSS reduction (p<0.01). Neither BPH patterns based on the Wassermann type nor modified BPH classifications were significantly related with postinterventional IPSS and volume loss. Conclusions Men benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume, presence of AdBPH on MRI, and IPSS should be considered for outcome prognosis after prostatic artery embolization.

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“…Maclean et al found, over a 3-year follow-up period, 33.3% of PAE patients underwent a further procedure; although at their institution they initially did not consider rPAE as a viable option, they note in their discussion that they are changing their policy based on emerging data to include rPAE [14]. In the 10 patients who suffered recurrence in Monreal et al's study, 8 patients elected for surgical options and only one patient was treated with rPAE [15].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

Kearns

Boardman

Tapping

2020

Cardiovasc Intervent Radiol

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Purpose To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. Materials and Methods We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical followup occurred at a minimum of 3 months. Results 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p \ 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). Conclusion We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery.

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The First 48 Consecutive Patients with 3-Year Symptom Score Follow-Up Post-Prostate Artery Embolization (PAE) at a Single-Centre University Hospital

Cited by 8 publications

References 20 publications

Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes

Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes

Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization

Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

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