Factors Predicting a Good Symptomatic Outcome After Prostate Artery Embolisation (PAE)

Maclean, Drew; Harris, Mark; Drake, Thomas M; Maher, Ben; Modi, Sachin; Dyer, Jonathan; Somani, Bhaskar K.; Hacking, Nigel; Bryant, Tim

doi:10.1007/s00270-018-1912-5

Cited by 48 publications

(38 citation statements)

References 19 publications

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“…The effect of PAE on ejaculatory function was reported by 11 of the reviewed studies. There were no instances of retrograde ejaculation in 5 cohort studies totaling 340 patients (39,41,43,44,46,48), 1 cohort (34) reported 5 of 51 cases with dry or reduced ejaculation after PAE, and another cohort (35) showed reduced ejaculation in 14 of 97 patients. In the prospective UK-ROPE registry (32), 24.1% of patients reported retrograde ejaculation following PAE; however, the data were confounded by many patients having preexisting retrograde ejaculation related to medical therapy.…”

Section: Safety Of Paementioning

confidence: 99%

“…The other 16 unique cohort studies at different institutions all reported similar positive outcomes in terms of efficacy and safety. Considering the 7 cohort studies of PAE with 25 or more patients and 1 year or longer follow-up (35,40,41,43,44,48,50), mean IPSS improvement ranged from 11.2 to 18.0 points and QOL improvement ranged from 1.9 to 4.7 points. Technical success rates were 93.2%-100% for unilateral embolization and 86.3%-97.4% for bilateral embolization.…”

Section: Cohort Studiesmentioning

confidence: 99%

“…A number of recent studies have focused on PAE for LUTS in patients with prostate volumes exceeding 80-100 cm 3 . A Russian cohort of 88 patients with prostate volume > 80 cm 3 Three studies made direct comparisons between PAE in different prostate sizes (41,47,56). An American study (41) analyzed outcomes of PAE performed in patients with prostate volumes < 50 cm 3 , 50-80 cm 3 , and > 80 cm 3 .…”

Section: Specific Clinical Scenarios Very Large Prostatesmentioning

confidence: 99%

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Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology

McWilliams

Bilhim²,

Carnevale

et al. 2019

Journal of Vascular and Interventional Radiology

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BPH ¼ benign prostatic hyperplasia, IIEF ¼ International Index of Erectile Function, IPSS ¼ International Prostate Symptom Score, LUTS ¼ lower urinary tract symptoms, MIST ¼ minimally invasive surgical therapies, OP ¼ open prostatectomy, PAE ¼ prostatic artery embolization, PVR ¼ postvoid residual, QOL ¼ quality of life, RCT ¼ randomized controlled trial, TURP ¼ transurethral resection of the prostate, UK-ROPE ¼ United Kingdom Register of Prostate Embolization BACKGROUND Benign prostatic hyperplasia (BPH) describes the proliferation of the glandular and stromal tissue in the transition zone of the prostate, which may result in bladder outlet obstruction and consequent lower urinary tract symptoms (LUTS). The prevalence of BPH increases with age, affecting more than 70% of men older than 70 years (1), and one fourth of men older than 70 years have moderate to severe LUTS that impair their quality of life (QOL) (2,3). Thus, BPH and ensuing LUTS represent a significant health issue affecting millions of men. The International Prostate Symptom Score (IPSS; also known as the American Urologic Association Symptom Index) is a validated instrument that quantifies a patient's subjective urinary symptoms on a 35-point scale (4). The IPSS also incorporates a urinary QOL score, which assesses how the patient feels overall about his urinary symptoms. Nearly all studies assessing BPH treatments for LUTS use the IPSS and QOL scores to assess patients before and after treatment. A 3-point change in IPSS is noticeable by a man with LUTS (5), and a 30% reduction in IPSS is considered clinically acceptable for a treatment to be considered effective (6,7). Medical therapies, including a-1 blockers and 5-a reductase inhibitors, are the mainstay of treatment for mild to moderate LUTS. The symptomatic relief is relatively modest, with IPSS improvement in the range of 3-7 points (8). Although generally considered safe, medical

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Section: Safety Of Paementioning

confidence: 99%

Section: Cohort Studiesmentioning

confidence: 99%

Section: Specific Clinical Scenarios Very Large Prostatesmentioning

confidence: 99%

See 1 more Smart Citation

Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology

McWilliams

Bilhim²,

Carnevale

et al. 2019

Journal of Vascular and Interventional Radiology

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“…Outcome predictors of PAE have barely been investigated and conflicting results require elucidation. The aim of the present study was to assess the variability of treatment outcomes in a patient cohort undergoing PAE within a randomized, open‐label, non‐inferiority trial and to identify patient characteristics and findings related to the intervention that might allow improved patient selection and early estimation of PAE outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcome prediction of prostatic artery embolization: post hoc analysis of a randomized, open‐label, non‐inferiority trial

et al. 2018

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contributed equally to this work. ConclusionBaseline and peri-operative findings might help to guide patient selection and outcome prediction for PAE. Patients with larger prostates have a higher chance of success with PAE. Larger-scale clinical trials including a longer follow-up are warranted to further elucidate the most suitable patients for PAE. Keywordsprostatic artery embolization, benign prostatic hyperplasia, prostate, minimally invasive, lower urinary tract symptoms, treatment effect, #UroBPH, #PAE, #LUTS

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“…Questions that need to be addressed in the future include the appropriate spectrum of patients and indications for PAE. Though larger prostate volumes have been reported to be associated with a more successful outcome, little is known about outcome prediction and predisposing factors for treatment success or failure [32][33][34]. Considering its minimal invasiveness and the advantages addressed above, PAE may not only be considered as a substitute for invasive treatment of BPH-LUTS but also for medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Prostatic Artery Embolization versus Standard Surgical Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis

Zumstein

Betschart

Vetterlein

et al. 2019

European Urology Focus

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Context: Prostatic artery embolization (PAE) has been introduced into clinical practice for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS) despite a lack of high-level evidence. Objective: To perform a systematic review and meta-analysis of clinical trials comparing efficacy and safety of PAE versus established surgical therapies. Evidence acquisition: Medline, Embase, and York CRD were searched up to June 23, 2018. Only comparative studies were included. The risk of bias was assessed by the Cochrane Collaboration tool. Meta-analyses were performed using RevMan 5.3. Evidence synthesis: Five studies including 708 patients met the selection criteria. Risk of bias was rated high for most of the studies. Mean reduction in the International Prostate Symptom Score was lower after PAE compared with standard surgical therapies (mean difference 3.80 points [95% confidence interval: 2.77-4.83]; p < 0.001). PAE was less efficient regarding improvements in all functional parameters assessed including maximum urinary flow, post void residual, and reduction of prostate volume.In contrast, patient-reported erectile function (International Index of Erectile Function 5) was better after PAE and significantly fewer adverse events occurred after PAE. Conclusions: Moderately strong evidence confirms efficacy and safety of PAE in the treatment of BPH-LUTS in the short term. Significant advantages regarding safety and sexual function, but clear disadvantages regarding all other patient-reported and functional outcomes were found for PAE. Large-scale randomized controlled trials including longer follow-up periods are mandatory before PAE can be considered as a standard therapy and to define the ideal indication for PAE in the management of BPH-LUTS. Patient summary: We reviewed the role of prostatic artery embolization (PAE) in the treatment of symptoms associated with benign overgrowth of the prostate. The results suggest that PAE is not as effective as established surgical therapies but has fewer side y These authors contributed equally. * Corresponding author. Kantonsspital St. Gallen,

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Factors Predicting a Good Symptomatic Outcome After Prostate Artery Embolisation (PAE)

Abstract: Both the initial prostate size and percentage volume reduction at 3 months predict good symptomatic outcome at 12 months. These findings therefore aid patient selection and counselling to achieve optimal outcomes for men undergoing prostate artery embolisation.

Cited by 48 publications

References 19 publications

Outcome prediction of prostatic artery embolization: post hoc analysis of a randomized, open‐label, non‐inferiority trial

Prostatic Artery Embolization versus Standard Surgical Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis

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