Long-Term Data Presented for Prostatic Artery Embolization to Treat BPH
March 8, 2017—The Society of Interventional Radiology (SIR) announced the presentation of a study demonstrating that prostatic artery embolization (PAE), which reduces urinary tract symptoms for men with benign prostatic hyperplasia (BPH), maintains its effectiveness for at least 3 years after patients undergo the therapy.
According to SIR, the study of 1,000 men—which is the largest of its kind to evaluate the long-term effectiveness of PAE—was presented at the SIR 2017 annual scientific meeting in Washington, DC. The study investigators, led by João Martins Pisco, MD, also found that PAE is especially effective in men with BPH who also have acute urinary retention or the inability to voluntarily urinate and in patients with very large prostates who are normally treated with open surgery.
In the SIR announcement, Dr. Pisco, who is an interventional radiologist at St. Louis Hospital in Lisbon, Portugal, stated, "Our results demonstrate that this minimally invasive treatment is successful in the long term and should always be presented to patients who are exploring options to resolve their BPH."
Dr. Pisco continued, “PAE gives men with BPH a treatment option that is less invasive than other therapies and allows them to return to their normal lives sooner. Time and time again, I see patients who are relieved to find out about PAE because they are not able to tolerate medications for BPH due to their side effects. These men also don’t want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to PAE, which is generally performed under local anesthesia and on an outpatient basis.”
As summarized by SIR, Dr. Pisco and colleagues performed PAE on 1,000 men between March 2007 and March 2016. Patients' age averaged 67 years. All patients were evaluated in the short term (1, 3, and 6 months), 807 patients were seen through the medium term (every 6 months between 6 months and 3 years), and 406 patients were evaluated long term (every year after 3 years).
During each evaluation, the men’s symptoms were measured by the International Prostate Symptom Score, which tests for the blockage of urine flow, and the International Index of Erectile Function, which assesses erectile dysfunction. Investigators also measured the size of the prostate and the amount of urine left in the bladder after urination. They also evaluated the peak urinary flow rate and the prostate-specific antigen level, a test used to screen for prostate cancer.
The data from these measures revealed at the short-term mark that the treatment had an 89% cumulative success rate—measuring the success across all variables through the given testing period. The 807 men evaluated at the medium-term mark had an 82% success rate. And of the 406 patients measured at the long-term mark, 78% were considered cumulative successes.
In an additional analysis, investigators found that among 112 patients who also experienced acute urinary retention (AUR) before undergoing PAE, 106 (94.6%) had their catheter removed between 2 days and 3 months after treatment. At medium-term and long-term follow-up, 95 of the 112 (84.8%) and 89 of the 112 (78.5%) did not experience any recurrence of their AUR.
The team also performed PAE in 210 patients who had limited treatment options due to extreme enlargement of the prostate (larger than 100 cm3). Of these men, 84% experienced cumulative success at short-term evaluation and 76.2% at medium- and long-term evaluation. The normal size of a prostate is 15 cm3 to 30 cm3.
Dr. Pisco advised that although the study demonstrated that PAE was highly successful, the treatment may not be appropriate for all patients, such as those with advanced arterial atherosclerosis that may be caused by smoking or diabetes. He also noted that investigators are now conducting a study comparing the effectiveness of PAE with a sham treatment to address any possible placebo effect that may have occurred during the study with these 1,000 patients.
The study abstract (#1), “Short, Medium, and Long-Term Outcomes of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: 1,000 Patients,” can be accessed at sirmeeting.org.