Comprehensive Review on Current Controversies and Debate in Prostate Artery Embolization

Maclean, Drew; Bryant, Charles Timothy Francis; Vigneswaran, Ganesh; Bryant, J. T.; Harris, Mark; Somani, Bhaskar K.; Modi, Sachin

doi:10.5152/tud.2022.21337

Cited by 6 publications

(4 citation statements)

References 75 publications

(90 reference statements)

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“…There is some concern about the potential long-term consequences of radiation exposure from PAE [ 38 ]. As reflected in the included studies, PAE involves a longer procedure time than TURP and OSP, with a mean radiation exposure time of approximately 20–58 min [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis

Altman,

Ferreira,

Barragan

et al. 2024

BMC Urol

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Background To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). Methods A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. Results Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. Conclusion PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.

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Section: Discussionmentioning

confidence: 99%

Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis

Altman,

Ferreira,

Barragan

et al. 2024

BMC Urol

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“…Review of additional debates such as initial access choice (radial vs. femoral) and cost-effectiveness has been covered elsewhere. 19,20 Controversy No. 1: PAE Should Be Considered Alongside Medical Management First-line management for LUTS due to BPH includes lifestyle modifications and medical management with alpha-blockers, phosphodiesterase inhibitors, and/or 5-alpha reductase inhibitors (5ARI).…”

Section: Prostate Artery Embolization For Treatment Of Lower Urinary ...mentioning

confidence: 99%

“…Review of additional debates such as initial access choice (radial vs. femoral) and cost-effectiveness has been covered elsewhere. 19 20…”

Section: Prostate Artery Embolization For Treatment Of Lower Urinary ...mentioning

confidence: 99%

Controversies in Prostate Artery Embolization: Future Best Practice

Goyal

Salem

Mouli

2022

Semin intervent Radiol

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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.

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“…Patient selection remains one of the key issues surrounding prostate artery embolisation (PAE) [ 1 ] for treatment of benign prostatic hyperplasia (BPH). Identification of patients with the best chance of symptom improvement versus candidates who are unlikely to attain therapeutic success from PAE could serve as a vital strategy for averting superfluous interventions and reducing incidence of side-effects.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Comorbidities Do Not Impact Prostate Artery Embolisation (PAE) Outcomes: Retrospective Analysis of the National UK-ROPE Registry

Vigneswaran,

Maclean,

Doshi

et al. 2023

Cardiovasc Intervent Radiol

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Purpose Prostate artery embolisation (PAE) is a key treatment for the management of symptomatic benign prostatic hyperplasia (BPH). Common cardiovascular risk factors might be associated with suboptimal outcomes and thus influence patient treatment selection. The aim of the study was to evaluate whether cardiovascular comorbidities affect PAE outcomes. Methods Retrospective subset analysis of the UK Registry of Prostate Artery Embolisation (UK-ROPE) database was performed with patients who had a full documented past medical histories including hypertension, diabetes, coronary artery disease (CAD), diabetes and smoking status as well as international prostate symptom score (IPSS) at baseline and at 12 months. Multiple regression was performed to assess for any significant predictors. Results Comorbidity data were available for 100/216 patients (mean age 65.8 ± 6.4 years), baseline IPSS 20.9 ± 7.0). Regression analysis revealed that the presence of hypertension (53.7% IPSS reduction vs. absence 51.4%, p = 0.94), diabetes (52.6% vs. absence 52.1%, p = 0.6), CAD (59.2% vs. absence 51.4%, p = 0.95), no comorbidities (49.8% vs. any comorbidity present 55.3%, p = 0.66), smoking status (non-smoker, 52.6%, current smoker, 61.5%, ex-smoker, 49.8%, p > 0.05), age (p = 0.52) and baseline Qmax (p = 0.41) did not significantly impact IPSS reduction at 12 months post-PAE. Baseline prostate volume significantly influenced IPSS reduction (≥ 80 cc prostates, 58.9% vs. < 80 cc prostates 43.2%, p < 0.05). Conclusion The presence of cardiovascular comorbidities/smoking history does not appear to significantly impact PAE symptom score outcomes at 12 months post procedure. Our findings suggest that if the prostatic artery can be accessed, then clinical success is comparable to those without cardiovascular comorbidities. Graphical Abstract

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Comprehensive Review on Current Controversies and Debate in Prostate Artery Embolization

Cited by 6 publications

References 75 publications

Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis

Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis

Controversies in Prostate Artery Embolization: Future Best Practice

Cardiovascular Comorbidities Do Not Impact Prostate Artery Embolisation (PAE) Outcomes: Retrospective Analysis of the National UK-ROPE Registry

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