Prostatic artery embolisation – an option for select BPO patients
Reviewed byGokul Vignesh Kanda Swamy

Few proponents of prostatic artery embolisation (PAE) regard it as a potential standard in future for benign prostatic obstruction (BPO) / benign prostatic hyperplasia (BPH) treatment. Present guidelines from the National Institute for Health & Care Excellence (NICE) and the Urological Society of Australia and New Zealand (USANZ) consider this an option only under a context of study or research. The procedure is well utilised in refractory prostatic bleeds in unfit patients at present. This single centre study looks at the benefit and safety of the procedure in patients with prostate volume more than 80gms and with Charlson’s comorbidity index > two. Other inclusion criteria were International Prostate Symptom Score (IPSS) >12, Qmax <15ml/s, and symptomatic BPO refractory to drugs. Exclusion criteria were neurogenic bladder, sphincter decompensation, coagulation disorders, anticoagulant / platelet therapy, chronic kidney disease (CKD), previous surgical or five-alpha reductase inhibitors (5ARI) treatment, life expectancy <two years, bladder stones, indwelling catheter, or retention in the last four weeks. Primary endpoints were reduction of seven points in IPSS and increase in Qmax. Secondary endpoints were reduction of total prostate volume (TPV), post-void residual (PVR), prostate specific antigen (PSA), International Index of Erectile Function (IIEF) - five score, and Quality of Life (QoL). Follow-up was at three, six and twelve months. Tri-acryl microspheres 300-500 micrometer in diameter were used for embolisation using selective digital subtraction angiography. The procedure was undertaken bilaterally. In the study, at one year, the mean IPSS (10.40 vs. 23.98; P<.005); the mean Qmax (16.89 vs 7.28; P<0.05); PVR (18.38 vs. 75.25; P<0.05); TPV (71.20 vs. 129.31; P<0.05), PSA level (2.12 vs. 3.67; P<0.05), and QoL (5.10 vs. 2.20; P<0.05) were significantly better with respect to baseline but not in mean IIEF-5 score. No complications were reported apart from haematospermia in one patient. The median operative time was 84 minutes (68-101). All patients were discharged on the same day. The strengths of the study are clear inclusion and exclusion criteria and powered sample size. Limitations are – a single centre study with no comparative arm and which used only a single size of embolic agent. It discusses ideas for future studies on pathologic analysis of prostate specimens and cost-effectiveness of PAE and throws a ray of hope to these patients who are mostly unfit for definitive treatment for BPO. – GVK

Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study.
Kurbatov D, Russo GI, Sansalone S, et al.
UROLOGY
2014; Epub ahead of print.