1
|
Goyal P, Salem R, Mouli SK. Controversies in Prostate Artery Embolization: Future Best Practice. Semin Intervent Radiol 2022; 39:562-570. [PMID: 36561793 PMCID: PMC9767779 DOI: 10.1055/s-0042-1759701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.
Collapse
Affiliation(s)
- Piyush Goyal
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Samdeep K. Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
2
|
Degenerated, Pouch-Shaped, Intermittently Protruding Median Lobe Causing Early Symptomatic Recurrence After Prostatic Artery Embolization. Cardiovasc Intervent Radiol 2022; 45:1411-1414. [PMID: 35835872 DOI: 10.1007/s00270-022-03217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/25/2022] [Indexed: 11/02/2022]
|
3
|
Insausti I, Galbete A, Lucas-Cava V, de Ocáriz AS, Solchaga S, Monreal R, de la Cuesta AM, Alfaro R, Sun F, Montesino M, Urtasun F, Bilbao Jaureguízar JI. Prostatic Artery Embolization (PAE) Using Polyethylene Glycol Microspheres: Safety and Efficacy in 81 Patients. Cardiovasc Intervent Radiol 2022; 45:1339-1348. [PMID: 35655035 PMCID: PMC9458568 DOI: 10.1007/s00270-022-03165-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/26/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of prostatic artery embolization (PAE) using polyethylene glycol microspheres (PEGM) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This multicentric prospective study enrolled 81 patients who underwent PAE with 400 ± 75 µm PEGM (HydroPearl®, Terumo, Japan). Results from baseline and 1-, 3-, 6-, and 12-month follow-ups were assessed for subjective outcomes including International Prostate Symptoms Score (IPSS), Quality of life (QoL), and International Index of Erectile Function, and objective outcomes such as peak urinary flow (Qmax) and post-void residual volume (PVR). The visual analogue scale, satisfaction questionnaire, prostatic volume, and prostatic specific antigen levels were also evaluated. Complications were documented using the modified Clavien-Dindo classification. RESULTS Technical success was obtained in all patients. Clinical success was achieved in 78.5% of patients. Before PAE, 54.3% of patients had an indwelling catheter which was removed in 75% of them after procedure. A statistically significant decrease was observed in IPSS and QoL from baseline to 12 months (20.14 vs 5.89; 4.8 vs 0.63, P < .01), respectively. Objective outcomes also showed a statistically significant improvement in Qmax (+ 114.9%; P < .01), achieving a maximum urinary flow of 14.2 mL/sec, and PVR (decrease 58%; P < .05) at 12 months. Minor complications (Clavien-Dindo grades I-II) occurred in 13.6% of patients, without major complications observed. CONCLUSION PAE with PEGM is safe and effective treatment in patients with symptomatic BPH, with a significant improvement in both subjective and objective outcomes.
Collapse
Affiliation(s)
- Iñigo Insausti
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Arkaitz Galbete
- Universidad Pública de Navarra–Navarrabiomed–Hospital Universitario de Navarra, Redissec, Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Vanesa Lucas-Cava
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Ana Sáez de Ocáriz
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Saioa Solchaga
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Raquel Monreal
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Raquel Alfaro
- Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
| | - Fei Sun
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Manuel Montesino
- Department of Urology. Hospital, Universitario de Navarra, Pamplona, Spain
| | - Fermin Urtasun
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | | |
Collapse
|
4
|
Roberts DG, Callese TE, Okafor E, Naik P, Harrison B, Tse G, Plotnik AN, McWilliams JP. Prostatic Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Call for Universal Adoption of Ejaculatory Function Reporting. J Vasc Interv Radiol 2020; 31:2153-2156. [PMID: 33139187 DOI: 10.1016/j.jvir.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dustin G Roberts
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Tyler E Callese
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeka Okafor
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Priyanka Naik
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Brittany Harrison
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gary Tse
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Adam N Plotnik
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 200 UCLA Med Plaza, Los Angeles, CA 90095; David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
5
|
Powell T, Bhatia S, Ayyagari R. Current Debates Regarding Optimal Patient Evaluation and Procedural Technique for Prostatic Artery Embolization. Tech Vasc Interv Radiol 2020; 23:100696. [PMID: 33308526 DOI: 10.1016/j.tvir.2020.100696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There are active debates surrounding patient evaluation and procedural techniques of prostate artery embolization. This review evaluates the available evidence on the value of urodynamics, the effect of prostate gland size, the benefits of pre- and intraprocedural cross-sectional imaging, the utility of a balloon-occlusion microcatheter, the differences among embolic particle sizes and types, and the merits of radial versus femoral arterial access.
Collapse
Affiliation(s)
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Raj Ayyagari
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
6
|
Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Prospective Randomized Trial of 100-300 μm versus 300-500 μm versus 100- to 300-μm + 300- to 500-μm Embospheres. J Vasc Interv Radiol 2019; 30:638-644. [PMID: 31029381 DOI: 10.1016/j.jvir.2019.02.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study compared the safety and efficacy of prostatic arterial embolization (PAE) with that of trisacryl gelatin microspheres of different sizes for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This study consisted of a single-center, randomized controlled clinical trial in 138 patients who underwent PAE for BPH between July 2015 and December 2016. Patients were randomized to PAE using microspheres of different sizes: group A patients were treated with microspheres 100-300 μm, group B with 300-500 μm, and group C with 100-300 μm followed by 300-500 μm. All patients were evaluated before and at 1, 3, 6, 12, and 18 months after PAE. Baseline data were comparable across the 3 groups, using the following mean International Prostate Symptom Score/quality of life (IPSS/QoL); prostate volume (PV) scores, respectively: 23.0/4.14; 87.9 cm3 (group A); 23.0/4.09; 89.0 cm3 (group B); and 24.2/4.29; 81.0 cm3 (group C) (P > 0.05). RESULTS Mean IPSS/QoL scores; PV after PAE were: 9.98/2.49; 65.1 cm3 (group A); 8.24/2.26; 63.1 cm3 (group B); and 10.1/2.69; 53.1 cm3 (group C) (P = 0.23; P = 0.39; P = 0.24). There were 26 clinical failures. The cumulative probabilities of clinical success at 18 months were 76.7% in group A, 82.6% in group B, and 83.3% in group C (P = 0.68). Nontarget embolization was prevented in 6 patients by coil embolization. All adverse events were mild and self-limited with rates of 86.0% in group A (37 of 43); 41.3% in group B (19 of 46); and 58.3% in group C (28 of 48) (P < 0.001). Dysuria was the most frequent adverse event (28 of 137 [20.4%]). CONCLUSIONS PAE outcomes were not significantly different among microspheres of different sizes. The use of 100- to 300-μm microspheres was associated with an increased risk of minor adverse events.
Collapse
|
7
|
Randomized Clinical Trial of Balloon Occlusion versus Conventional Microcatheter Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2019; 30:1798-1806. [DOI: 10.1016/j.jvir.2019.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/22/2022] Open
|
8
|
Dias JL, Bilhim T. Modern imaging and image-guided treatments of the prostate gland: MR and ablation for cancer and prostatic artery embolization for benign prostatic hyperplasia. BJR Open 2019; 1:20190019. [PMID: 33178947 PMCID: PMC7592499 DOI: 10.1259/bjro.20190019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/04/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
Multiparametric MRI (mpMRI) has proven to be an essential tool for diagnosis, post-treatment follow-up, aggressiveness assessment, and active surveillance of prostate cancer. Currently, this imaging technique is part of the daily practice in many oncological centres. This manuscript aims to review the use of mpMRI in the set of prostatic diseases, either malignant or benign: mpMRI to detect and stage prostate cancer is discussed, as well as its use for active surveillance. Image-guided ablation techniques for prostate cancer are also reviewed. The need to establish minimum acceptable technical parameters for prostate mpMRI, standardize reports, uniform terminology for describing imaging findings, and develop assessment categories that differentiate levels of suspicion for clinically significant prostate cancer led to the development of the Prostate Imaging Reporting and Data System that is reviewed. Special focus will also be given on the most up-to-date evidence of prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH). Management of patients with BPH, technical aspects of PAE, expected outcomes and level of evidence are reviewed with the most recent literature. PAE is a challenging technique that requires dedicated anatomical knowledge and comprehensive embolization skills. PAE has been shown to be an effective minimally-invasive treatment option for symptomatic BPH patients, that can be viewed between medical therapy and surgery. PAE may be a good option for symptomatic BPH patients that do not want to be operated and can obviate the need for prostatic surgery in up to 80% of treated patients.
Collapse
|