The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Abstract

Objective: Prostatic artery embolization (PAE) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) is believed to be a safe procedure with a low risk of adverse side effects. Artery embolization is a viable treatment option in patients who are refractory to the classic noninvasive treatments. Knowledge of the histological characteristics of prostate tissue following the procedure is still limited. In this study, we describe the microscopic aspects of the prostate following PAE for BPH. Materials and Methods: Two patients underwent transurethral resections of the prostate (TURP) after PAE. Embolizations were performed under local anesthesia with an initial pelvic angiography to evaluate the iliac vessels and the prostate arteries using a 2.8 French microcatheter. The prostate was embolized with 300-500μm Microspheres (Embosphere®), using complete blood stasis as the end point. The prostate tissues were analyzed histologically to characterize the effects of the embolization. Results: The embolic material within the prostate tissue was easily identified as homogeneous, bright eosin-red spheroids filling the vessel lumens. Ischemic necrosis surrounded or not by chronic inflammatory reactions containing macrophages were considered as a result of the artery embolization. Also, some aspects related to the healing process were observed being fibrotic nodules surrounded by glands with squamous metaplasia of the epithelial lining the most important. In the remaining sections, due to the precocious surgical intervention, the classic findings of BPH were still present with the glandular and stromal hyperplasia associated with nonspecific chronic prostatitis. Conclusions: This is the first description of prostate histology in BPH patients treated by PAE, a new procedure that is being used increasingly as a therapeutic intervention. The recognition of the changes caused by this new modality of treatment has become a very important differential in a chronic granulomatous reaction of the prostate tissue.

Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis

“…This may be from the TURP achieving a radical resection of an enlarged volume. It may take longer after PAE to achieve the histopathologic changes associated with destruction of the prostate vasculature [17]. However, the PAE could not make a big change for non-radical removal of the prostate volume.…”

State of the art of prostatic arterial embolization for benign prostatic hyperplasia

“…In addition to IPSS and QoL, clinical success of PAE is also quantified in terms of Qmax, PV, PVR and IIEF. As the aim of PAE is to cause ischemic necrosis and shrinkage of the prostate gland (54), it is reasonable to assume that clinical improvement goes together with PV reduction and long-term PSA value decrease, in proportion with the extension of infarction area.…”

Prostate volume measured by magnetic resonance imaging is not a predictor of lower urinary tract symptoms

“…[1] It has been suggested that PAE results in a great reduction of prostate size, and that gland necrosis is the cause for reduction in prostate volume. [78] In one study, a patient had 47% volume reduction at 6 months following bilateral PAE, while another showed 28% reduction after unilateral PAE. [7] However, PAE has also been shown to successfully treat LUTS without reduction in prostate volume.…”