Prostatic Artery Embolization Data Show Reduced Nighttime Waking, Improved Quality of Life

April 4, 2016—New data regarding prostatic artery embolization (PAE) for treatment of benign prostatic hyperplasia (BPH) show that patients undergoing the procedure reported reductions in nocturia, resulting in better sleep and improved quality of life.

Researchers at the Vascular Institute of Virginia and the University of North Carolina at Chapel Hill collaborated to conduct a retrospective analysis of 68 patients with BPH and lower urinary tract symptoms who had undergone PAE. Sandeep Bagla, MD, and colleagues shared the findings during the Society of Interventional Radiology’s 2016 Annual Scientific Meeting in Vancouver, British Columbia. 

In the study, patients were asked to self-report quality of life scores ranging 0 (delighted with their current status) to 6 (current condition is unbearable) and also answered an American Urological Association (AUA) symptom index questionnaire regarding the negative effects of their urinary symptoms. Scores in this index range from 0 to 35, with 0 representing not being bothered by urinary symptoms and 35 indicating being very bothered by them. 

In both metrics, improvements were observed. The average AUA score reported before treatment was 23.9, and the average pretreatment quality of life score was 4.8. Frequency of overnight urination was 3.3 episodes per patient on average. 

Of the 68 patients originally included (mean age, 64.6 years), 46 gave responses again at 1 month postprocedure. These patients saw an average 10-point reduction AUA score and an average absolute reduction in nocturia frequency of 0.85 episodes per night. Quality of life scores were noted to have improved by 2.1 on average. 

When scores were collected in 38 patients at 3 months, 28 reported reduced episode frequency (average reduction of 1.4 episodes per night), as well as a 13.4-point reduction in AUA score and a 2.8-point improvement in quality of life score. 

Dr. Bagla discussed PAE trends and the results of the study with the media. Regarding whether symptom improvement was tied to reduction in gland size, Dr. Bagla first noted that in the study, patients did not undergo imaging concurrently with their questionnaires at follow-up. However, he did speak to observations from previous studies and current theories as to what causes the reduction in symptoms.

“Although we do expect between 20% and 30% volume reduction in prostatic gland size after PAE, there is no correlation between gland size reduction and symptom improvement,” said Dr. Bagla. This, he continued, begs the question as to why patients are seeing such significant improvement in symptoms after the procedure. “Much of the improvement may be due to softening of the prostatic gland in patients who don’t see a lot of gland size reduction, allowing the urethra easier passage of urine.” 

Another theory as to what causes symptom relief in these patients as described by Dr. Bagla is that much of the prostate's sympathetic nervous system, which stimulates a narrowed urethra, is composed of alpha receptors, the same type that medical therapies target. After PAE, it is possible the area of tissue that is no longer viable due to the embolization is also diminished in terms of its alpha receptor activity, and this relaxation of the gland allows symptoms to improve, he suggested. 

Previous PAE data from Dr. Bagla and colleagues were highlighted at SIR 2015, and he also discussed the clinical experience to date in an interview with Endovascular Today.