April 18, 2019
Multisociety Position Statement Supports PAE to Treat Lower Urinary Tract Symptoms Attributed to BPH
April 19, 2019—A multisociety consensus position statement on prostate artery embolization (PAE) for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) was published by Justin P. McWilliams, MD, et al in Journal of Vascular and Interventional Radiology (JVIR).
The document, which reviews the updated global experience with PAE and defines the shared understanding and recommendations for this condition and its treatment from the Society of Interventional Radiology (SIR), the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology. Additionally, the statement is endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology.
As noted in JVIR, SIR published an initial position statement on PAE for BPH in 2014. That statement concluded that PAE was a safe and effective treatment for BPH and recommended further clinical investigation, including the expansion of the number of patients treated, increase in the duration of follow-up, and inclusion of more prospective comparisons with surgical therapies. Since that time, substantial research has accumulated, and clinical practice patterns are evolving.
The 2019 document advises that the data supporting PAE for BPH have advanced since the 2014 statement and confirm that PAE is a safe and effective treatment for BPH with good short-term and midterm durability.
The consensus position of the societies on PAE includes:
- The symptomatic and quality-of-life improvement approach seen with transurethral resection of the prostate and open prostatectomy, and subjective and objective measures compare favorably to urologic minimally invasive surgical therapies.
- The minimally invasive nature of the PAE technique results in very low morbidity and expands the pool of patients who are eligible for therapy.
- Based on comprehensive review, the societies jointly conclude that current evidence is adequate to support the use of PAE for BPH in appropriately selected patients.
Based on the updated SIR methodology for evidence grading, the societies make the following recommendations in JVIR:
- PAE is an acceptable minimally invasive treatment option for appropriately selected men with BPH and moderate to severe LUTS. (Level of evidence [LoE]: B; strength of recommendation [SoR]: strong)
- PAE can be considered as a treatment option in patients with BPH and moderate to severe LUTS who have very large prostate glands (> 80 cm3), without an upper limit of prostate size. (LoE: C; SoR: moderate)
- PAE can be considered as a treatment option in patients with BPH and acute or chronic urinary retention in the setting of preserved bladder function as a method of achieving catheter independence. (LoE: C; SoR: moderate)
- PAE can be considered as a treatment option in patients with BPH and moderate to severe LUTS who wish to preserve erectile and/or ejaculatory function. (LoE: C; SoR: weak)
- PAE can be considered in patients with hematuria of prostatic origin as a method of achieving cessation of bleeding. (LoE: D; SoR: strong)
- PAE can be considered as a treatment option in patients with BPH and moderate to severe LUTS who are deemed not to be surgical candidates for any of the following reasons: advanced age, multiple comorbidities, coagulopathy, or inability to stop anticoagulation or antiplatelet therapy. (LoE: E; SoR: moderate)
- PAE should be included in the individualized patient-centered discussion regarding treatment options for BPH with LUTS. (LoE: E; SoR: strong)
- Interventional radiologists, given their knowledge of arterial anatomy, advanced microcatheter techniques, and expertise in embolization procedures, are the specialists best suited for the performance of PAE. (LoE: E; SoR: strong)