The State of Evidence in Prostate Artery Embolization

Abstract

Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.

Prostate Artery Embolization (PAE) with Small Beads for the Treatment of Benign Prostatic Hyperplasia (BPH)

“…Conversely, PAE has emerged as a compelling therapeutic avenue for the management of LUTS attributed to BPH. PAE not only yields outcomes akin to those achieved through TURP but also mitigates operative risks [ 39 , 40 , 41 , 42 ]. A salient advantage of PAE is its adaptability to prostates exceeding the volumetric threshold of 100 mL, with consistently favorable clinical outcomes [ 57 ].…”

“…According to the Society of Interventional Radiology (SIR), Prostate Artery Embolization (PAE) represents a viable therapeutic avenue for addressing LUTS attributed to BPH, exhibiting comparable efficacy to surgical interventions [ 16 , 39 , 40 , 41 , 42 ]. The allure of PAE is further accentuated by its associated benefits, including reduced hospitalization durations, diminished transfusion risks, and a low incidence of sexual dysfunction [ 16 , 41 , 43 ].…”

“…Initially relegated to emergency scenarios such as hemorrhage, PAE has demonstrated remarkable efficacy in reducing prostate volume, albeit with delayed onset of action and fewer procedure-related risks compared to surgical interventions [ 44 ]. Presently, PAE emerges as an optimal strategy for patients unsuitable for surgery, those averse to surgical interventions, or individuals prioritizing the preservation of sexual function [ 16 , 40 ].…”

Surgical and procedural management of benign prostatic hyperplasia

“…These trials also demonstrated a trend toward fewer adverse events with PAE than with TURP, particularly in terms of sexual dysfunction. 4,5 The most recent American Urological Association guidelines for the management of lower urinary tract symptoms secondary to BPH include PAE, performed by an experienced physician, as a potential treatment option. 2 We agree that PAE can serve as a useful complement to offi ce-based and surgical procedures, and with its addition we are able to offer effective and safe treatment for all patients, irrespective of prostate size, medical comorbidities, or need for anticoagulant or antiplatelet medications.…”