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Sunday, September 21, 2014

Minimally invasive therapy for prostate enlargement provides alternative to surgical or endoscopic treatment

Benign prostatic hyperplasia (BPH) affects as many as 90% of all men aged 70-89 years and leads to over 4 million annual doctor visits resulting in over 1 billion dollars in direct healthcare costs annually. Patients with moderate to severe symptoms related to BPH and in whom medical therapies fail are typically treated with transurethral resection of the prostate (TURP) or prostatectomy.

In 2010, Prostate Artery Embolization (PAE) was first described to diminish blood supply to the prostate and reduce its size. The clinical trials and the science backing PAE are explored in the September edition of the Journal of Vascular and Interventional Radiology. A number of studies reviewed in this JVIR consensus paper validate the efficacy of PAE in reducing urinary symptoms from BPH. When compared in a head-to-head study with TURP, both methods showed similar efficacy, with PAE providing the advantage of less bleeding and lower rates of urinary catheterization. PAE also does not require general anesthesia, imparts little pain, and is associated with minimal blood loss. While the authors note that PAE can be technically challenging to perform, quality of life scores following PAE show that patients are quite satisfied with the symptomatic relief that PAE provides when performed successfully. The authors conclude that current data regarding PAE shows promise.

Comments: 
The present article provides the foundation that PAE appears safe and efficacious based on short-term follow-up and is best performed by an Interventional Radiologist. Further, the SIR supports the performance of high-quality clinical research to expand the numbers of patients studied, to extend the duration of follow-up, and to compare the PAE procedure against existing surgical therapies.


To see the article in its entirety free of charge, click here.


To listen to a JVIR podcastinterview regarding this work, click here or visit JVIR on iTtunes.


(a) Coronal T2-weighted MR image of the prostate demonstrates heterogeneous nodular enlargement of the central gland, with impingement on the bladder neck secondary to median lobe hypertrophy (black arrow). (b) Selective angiography of the left prostatic artery (white arrow) shows an enlarged prostate gland with increased vascularity in the central gland. (c) Coronal reformatted image from cone-beam CT after left prostatic artery injection depicts near-homogenous perfusion of the left hemiprostate (black asterisk), without evidence of potential nontarget embolization. (d) Angiogram after embolization to a target endpoint of near-stasis shows a lack of significant parenchymal perfusion.


Citation:  McWilliams, J. P. et al. Society of Interventional Radiology Position Statement: Prostate Artery Embolization for Treatment of Benign Disease of the Prostate. Journal of Vascular and Interventional Radiology 25, 1349–1351 (2014).


Images: Bagla, S. et al. Early Results from a United States Trial of Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia. Journal of Vascular and Interventional Radiology 25, 47–52 (2014).


Post author: Austin Bourgeois, MD

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