Indications for prostate artery embolization: a limited cohort study from a single tertiary care institution
Britney Atwater, BS, Scott Greenberg, MD, Mitchell Bamberger, MD, MBA, Stephan Wicky van Doyer, MD, Hesham Malik, MD. UMass Medical School, Worcester, MA, USA.
Background
Prostate artery embolization (PAE) is a minimally invasive treatment modality that is gaining interest for lower urinary tract symptoms (LUTS) and other urologic conditions. AUA guidelines categorize PAE as experimental due to lack of consistent study data and safety concerns. This retrospective analysis explores the experiences at a single tertiary care institution characterizing unique indications for PAE.
Methods
Between September 2017 and August 2019, all patients undergoing PAE were enrolled into our database to study the demographics, indications, and outcomes of patients treated with this relatively novel intervention.
Results
Eleven patients underwent PAE for the following indications: prostate cancer and LUTS (n=1), LUTS (n=5), LUTS and hematuria (n=3), and refractory hematuria (n=2). Patients were eligible for PAE if they experienced blood loss requiring transfusions, persistent gross hematuria, failure of conservative management, or were poor surgical candidates. Pre- and post-PAE imaging with prostate volume measurement demonstrated an average decrease of 27 mL (n=2). Pre- and post-PAE IPSS averaged 19.3 and 9.3, respectively (n=3). Six out of eleven patients had symptomatic improvement, four had no improvement, and one lacks sufficient documentation regarding his clinical outcome. One patient required repeat PAE for persistent BOO symptoms.
Conclusions
We propose the following clinical scenarios for which to consider PAE: 1) failure of conservative treatments for LUTS, 2) coagulopathy with active prostatic bleeding, 3) poor surgical candidates, and 4) patients requiring prostate intervention who have concerns about sexual dysfunction. Additional prospective studies are needed to further explore the indications for and long-term results of PAE.
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