UK NICE Guidance Updated to Support Use of Prostate Artery Embolization

May 1, 2018—The United Kingdom's National Institute for Health and Care Excellence (NICE) announced the update of its guidance to allow the use of prostate artery embolization (PAE) as a treatment of benign prostatic hyperplasia.

According to NICE, it first reviewed PAE treatment in 2013 but decided that more research was required to determine whether the procedure was effective and safe. Since 2013, NICE has worked with the British Society of Interventional Radiology and the British Association of Urological Surgeons to coordinate the UK ROPE study.

The UK ROPE study compared PAE to conventional prostate surgery and found PAE was safe. It also provided a clinically and statistically significant improvement in symptoms and quality of life for men with enlarged prostate. Findings from the study were recently published online ahead of print in BJUI: British Journal of Urology International.

With the findings from this study and other new evidence, the NICE guidance has been updated to state that PAE can be offered to patients. The procedure should be performed by an interventional radiologist with specific training and expertise.

In the announcement, UK ROPE investigator Nigel Hacking, MD, commented, “Results from the study show PAE can help large numbers of men suffering with the symptoms of an enlarged prostate. It is a particularly good option for men who are not yet ready to undergo more invasive prostate surgery. Maintaining sexual function and fertility is one of its main strengths.” Dr. Hacking is consultant interventional radiologist at University Hospital in Southampton, United Kingdom.

Professor Kevin Harris, MD, who is clinical director for the NICE Interventional Procedures program, added, “This is an excellent example of what can be achieved when we work together effectively across the system. NICE flagged the need for more evidence and that is exactly what we have received. The availability of this procedure could make a real difference to the lives of men up and down the country.”

In commentary to Endovascular Today, Dr. Hacking further discussed the implication of the new guidance. He stated, "A decade after Francisco Carnevale, MD, did his first PAE for benign prostatic hyperplasia, we now have the strongest approval yet for the procedure. PAE is safe. PAE is efficacious. Now we can work closely with our Urology colleagues to expand services and offer a real choice to symptomatic men as a bridge between drug therapy and more invasive prostatectomy. PAE is a highly skilled procedure and requires the specialized skills and additional training of an interventional radiologist to provide the level of safety required by NICE."

In our April edition on embolization, Dr. Hacking provided his perspective on PAE's current role and future potentialahead of the NICE guideline release. Sandeep Bagla, MD, of the Vascular Institute of Virginia,offered a US perspective.