PDF herunterladen
Semin intervent Radiol 2022; 39(06): 562-570
DOI: 10.1055/s-0042-1759701
Review Article

Controversies in Prostate Artery Embolization: Future Best Practice

Piyush Goyal
1   Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
,
Riad Salem
1   Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
,
Samdeep K. Mouli
1   Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.

Keywords

prostatic artery embolization - benign prostatic hypertrophy - International Prostate Symptom Score - transurethral prostatectomy - embolization


Publikationsverlauf

Artikel online veröffentlicht:
20. Dezember 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lerner LB, McVary KT, Barry MJ. et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA GUIDELINE PART I-initial work-up and medical management. J Urol 2021; 206 (04) 806-817
    CrossrefPubMedGoogle Scholar
  • 2 Madersbacher S, Sampson N, Culig Z. Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: a mini-review. Gerontology 2019; 65 (05) 458-464
    CrossrefPubMedGoogle Scholar
  • 3 Naidu SG, Narayanan H, Saini G. et al. Prostate artery embolization - review of indications, patient selection, techniques and results. J Clin Med 2021; 10 (21) 5139
    CrossrefPubMedGoogle Scholar
  • 4 Narayanamurthy V, Mishra K, Mahran A, Bukavina L, Ponsky L, Gnessin E. Inter-imaging accuracy of computed tomography, magnetic resonance imaging, and transrectal ultrasound in measuring prostate volume compared to the anatomic prostatic weight. Turk J Urol 2020; 46 (01) 50-56
    CrossrefPubMedGoogle Scholar
  • 5 Pisco JM, Bilhim T, Costa NV. et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol 2020; 77 (03) 354-362
    CrossrefPubMedGoogle Scholar
  • 6 Tapping CR, Little MW, Macdonald A. et al. The STREAM Trial (Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia) 24-month clinical and radiological outcomes. Cardiovasc Intervent Radiol 2021; 44 (03) 436-442
    CrossrefPubMedGoogle Scholar
  • 7 de Assis AM, Moreira AM, Carnevale FC. et al. Role of ultrasound elastography in patient selection for prostatic artery embolization. J Vasc Interv Radiol 2021; 32 (10) 1410-1416
    CrossrefPubMedGoogle Scholar
  • 8 Abt D, Müllhaupt G, Hechelhammer L. et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic hyperplasia: 2-yr outcomes of a randomised, open-label, single-centre trial. Eur Urol 2021; 80 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 9 Insausti I, Sáez de Ocáriz A, Galbete A. et al. Randomized comparison of prostatic artery embolization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 2020; 31 (06) 882-890
    CrossrefPubMedGoogle Scholar
  • 10 Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E. Long-term outcome of prostatic artery embolization for patients with benign prostatic hyperplasia: single-centre retrospective study in 1072 patients over a 10-year period. Cardiovasc Intervent Radiol 2022; 45 (09) 1324-1336
    CrossrefPubMedGoogle Scholar
  • 11 Carnevale FC, Moreira AM, de Assis AM. et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years' experience. Radiology 2020; 296 (02) 444-451
    CrossrefPubMedGoogle Scholar
  • 12 Knight GM, Talwar A, Salem R, Mouli S. Systematic review and meta-analysis comparing prostatic artery embolization to gold-standard transurethral resection of the prostate for benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2021; 44 (02) 183-193
    CrossrefPubMedGoogle Scholar
  • 13 Bilhim T, Betschart P, Lyatoshinsky P, Müllhaupt G, Abt D. Minimally invasive therapies for benign prostatic obstruction: a review of currently available techniques including prostatic artery embolization, water vapor thermal therapy, prostatic urethral lift, temporary implantable nitinol device and aquablation. Cardiovasc Intervent Radiol 2022; 45 (04) 415-424
    CrossrefPubMedGoogle Scholar
  • 14 Sajan A, Mehta T, Desai P, Isaacson A, Bagla S. Minimally invasive treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. J Vasc Interv Radiol 2022; 33 (04) 359-367.e8
    CrossrefPubMedGoogle Scholar
  • 15 Kaplan SA. Re: Randomised clinical trial of prostate artery embolisation versus a sham procedure for benign prostatic hyperplasia. J Urol 2020; 204 (02) 357-358
    CrossrefPubMedGoogle Scholar
  • 16 Enikeev D, Misrai V, Rijo E. et al. EAU, AUA and NICE guidelines on surgical and minimally invasive treatment of benign prostate hyperplasia: a critical appraisal of the guidelines using the AGREE-II Tool. Urol Int 2022; 106 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 17 Mouli S, Hohlastos E, Salem R. Prostate artery embolization. Semin Intervent Radiol 2019; 36 (02) 142-148
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Darson MF, Alexander EE, Schiffman ZJ. et al. Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezūm system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Res Rep Urol 2017; 9: 159-168
    PubMedGoogle Scholar
  • 19 Powell T, Bhatia S, Ayyagari R. Current debates regarding optimal patient evaluation and procedural technique for prostatic artery embolization. Tech Vasc Interv Radiol 2020; 23 (03) 100696
    CrossrefPubMedGoogle Scholar
  • 20 Maclean D, Francis Bryant CT, Vigneswaran G. et al. Comprehensive review on current controversies and debate in prostate artery embolization. Turk J Urol 2022; 48 (03) 166-173
    CrossrefPubMedGoogle Scholar
  • 21 Gul ZG, Kaplan SA. BPH: Why do patients fail medical therapy?. Curr Urol Rep 2019; 20 (07) 40
    CrossrefPubMedGoogle Scholar
  • 22 Lusty A, Siemens DR, Tohidi M, Whitehead M, Tranmer J, Nickel JC. Cardiac failure associated with medical therapy of benign prostatic hyperplasia: a population based study. J Urol 2021; 205 (05) 1430-1437
    CrossrefPubMedGoogle Scholar
  • 23 Fogaing C, Alsulihem A, Campeau L, Corcos J. Is early surgical treatment for benign prostatic hyperplasia preferable to prolonged medical therapy: pros and cons. Medicina (Kaunas) 2021; 57 (04) 368
    CrossrefPubMedGoogle Scholar
  • 24 Chughtai B, Rojanasarot S, Neeser K. et al. A comprehensive analysis of clinical, quality of life, and cost-effectiveness outcomes of key treatment options for benign prostatic hyperplasia. PLoS One 2022; 17 (04) e0266824
    CrossrefPubMedGoogle Scholar
  • 25 LaRussa S, Pantuck M, Wilcox Vanden Berg R, Gaffney CD, Askin G, McClure T. Symptomatic improvement of lower urinary tract symptoms of benign prostatic hyperplasia: a comparative systematic review and meta-analysis of 4 different minimally invasive therapies. J Vasc Interv Radiol 2021; 32 (09) 1328-1340.e11
    CrossrefPubMedGoogle Scholar
  • 26 Bilhim T, Pisco J, Fernandes L, Costa NV, Oliveira AG. Surgical treatment: prostate artery embolization. In: Kasivisvanathan V, Challacombe B. eds. The Big Prostate. Springer International Publishing; 2018: 75-85
    Google Scholar
  • 27 Carnevale FC, McClure T, Cadour F. et al. Advanced image guidance for prostatic artery embolization - a multicenter technical note. CVIR Endovasc 2021; 4 (01) 63
    CrossrefPubMedGoogle Scholar
  • 28 Desai H, Yu H, Ohana E, Gunnell ET, Kim J, Isaacson A. Comparative analysis of cone-beam CT angiogram and conventional CT angiogram for prostatic artery identification prior to embolization. J Vasc Interv Radiol 2018; 29 (02) 229-232
    CrossrefPubMedGoogle Scholar
  • 29 Barral M, Gardavaud F, Lassalle L. et al. Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors. Eur Radiol 2021; 31 (09) 6471-6479
    CrossrefPubMedGoogle Scholar
  • 30 McClure TD, Ortiz AK, Doustaly R. et al. Use of virtual injection technology for planning and guidance of prostate artery embolization. Cardiovasc Intervent Radiol 2022; 45 (06) 884-887
    CrossrefPubMedGoogle Scholar
  • 31 Lionberg A, Nijhawan K, Navuluri R. et al. Hybrid angiography-CT for transarterial radioembolization: a pictorial essay. Abdom Radiol (NY) 2021; 46 (06) 2850-2854
    CrossrefPubMedGoogle Scholar
  • 32 Knox JA, Kumar V, Conrad MB, Nanavati S, Moore T, Wilson M. Synergy in IR-hybrid CT/C-arm in the setting of critical trauma. Emerg Radiol 2022; 29 (03) 605-609
    CrossrefPubMedGoogle Scholar
  • 33 Cui Z, Shukla PA, Habibollahi P, Park HS, Fischman A, Kolber MK. A systematic review of automated feeder detection software for locoregional treatment of hepatic tumors. Diagn Interv Imaging 2020; 101 (7-8): 439-449
    CrossrefPubMedGoogle Scholar
  • 34 GEST (Global Embolization Symposium & Technologies) 2022. J Vasc Interv Radiol 2022; 33 (06) e12-e51
    CrossrefPubMedGoogle Scholar
  • 35 Picel AC, Hsieh T-C, Shapiro RM, Vezeridis AM, Isaacson AJ. Prostatic artery embolization for benign prostatic hyperplasia: patient evaluation, anatomy, and technique for successful treatment. Radiographics 2019; 39 (05) 1526-1548
    CrossrefPubMedGoogle Scholar
  • 36 Railton N, Bryant TJ, Burney K, Stedman B, Hacking N. Abstract no. 55: clinical and radiological outcomes following uterine fibroid embolization (UFE) with either beadblock, embospheres, embozenes or gelfoam. J Vasc Interv Radiol 2010; 21 (02) S23
    CrossrefPubMedGoogle Scholar
  • 37 Salem R, Hairston J, Hohlastos E. et al. Prostate artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia: results from a prospective FDA-approved investigational device exemption study. Urology 2018; 120: 205-210
    CrossrefPubMedGoogle Scholar
  • 38 Insausti I, Galbete A, Lucas-Cava V. et al. Prostatic artery embolization (PAE) using polyethylene glycol microspheres: safety and efficacy in 81 patients. Cardiovasc Intervent Radiol 2022; 45 (09) 1339-1348
    CrossrefPubMedGoogle Scholar
  • 39 Loffroy R, Guillen K, Salet E. et al. Prostate artery embolization using N-butyl cyanoacrylate glue for urinary tract symptoms due to benign prostatic hyperplasia: a valid alternative to microparticles?. J Clin Med 2021; 10 (14) 3161
    CrossrefPubMedGoogle Scholar
  • 40 Hu J, Albadawi H, Chong BW. et al. Advances in biomaterials and technologies for vascular embolization. Adv Mater 2019; 31 (33) e1901071
    CrossrefPubMedGoogle Scholar
  • 41 Talaie R, Torkian P, Amili O. et al. Particle distribution in embolotherapy, how do they get there? A critical review of the factors affecting arterial distribution of embolic particles. Ann Biomed Eng 2022; 50 (08) 885-897
    CrossrefPubMedGoogle Scholar
  • 42 Wang MQ, Zhang JL, Xin HN. et al. Comparison of clinical outcomes of prostatic artery embolization with 50-μm plus 100-μm polyvinyl alcohol (PVA) particles versus 100-μm PVA particles alone: a prospective randomized trial. J Vasc Interv Radiol 2018; 29 (12) 1694-1702
    CrossrefPubMedGoogle Scholar
  • 43 Bilhim T, Pisco J, Pereira JA. et al. Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. Radiology 2016; 281 (01) 289-300
    CrossrefPubMedGoogle Scholar
  • 44 Torres D, Costa NV, Pisco J, Pinheiro LC, Oliveira AG, Bilhim T. Prostatic artery embolization for benign prostatic hyperplasia: prospective randomized trial of 100-300 μm versus 300-500 μm versus 100- to 300-μm + 300- to 500-μm embospheres. J Vasc Interv Radiol 2019; 30 (05) 638-644
    CrossrefPubMedGoogle Scholar
  • 45 Gonçalves OM, Carnevale FC, Moreira AM, Antunes AA, Rodrigues VC, Srougi M. Comparative study using 100-300 versus 300-500 μm microspheres for symptomatic patients due to enlarged-BPH prostates. Cardiovasc Intervent Radiol 2016; 39 (10) 1372-1378
    CrossrefPubMedGoogle Scholar
  • 46 Hechelhammer L, Müllhaupt G, Mordasini L. et al. Predictability and inducibility of detachment of prostatic central gland tissue after prostatic artery embolization: post hoc analysis of a randomized controlled trial. J Vasc Interv Radiol 2019; 30 (02) 217-224
    CrossrefPubMedGoogle Scholar
  • 47 Kim M, Song SH, Ku JH, Kim HJ, Paick JS. Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in Holmium laser enucleation of the prostate. Int J Impot Res 2015; 27 (01) 20-24
    CrossrefPubMedGoogle Scholar
  • 48 Bilhim T. Endovascular resection of the prostate: How much is enough for prostate artery embolization?. J Vasc Interv Radiol 2019; 30 (02) 225-227
    CrossrefPubMedGoogle Scholar
  • 49 Garcia-Monaco RD, Garategui LG, Onorati MV, Rosasco NM, Peralta OA. Cadaveric specimen study of prostate microvasculature: implications for arterial embolization. J Vasc Interv Radiol 2019; 30 (09) 1471-1479.e3
    CrossrefPubMedGoogle Scholar
  • 50 Salet E, Crombé A, Grenier N. et al. Prostatic artery embolization for benign prostatic obstruction: single-centre retrospective study comparing microspheres versus n-butyl cyanoacrylate. Cardiovasc Intervent Radiol 2022; 45 (06) 814-823
    CrossrefPubMedGoogle Scholar
  • 51 Loffroy R, Desmyttere A-S, Mouillot T. et al. Ten-year experience with arterial embolization for peptic ulcer bleeding: N-butyl cyanoacrylate glue versus other embolic agents. Eur Radiol 2021; 31 (05) 3015-3026
    CrossrefPubMedGoogle Scholar
  • 52 Jung JH, McCutcheon KA, Borofsky M. et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2022; 3 (03) CD012867
    PubMedGoogle Scholar
  • 53 Franco JV, Jung JH, Imamura M. et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database Syst Rev 2021; 7 (07) CD013656
    PubMedGoogle Scholar
  • 54 Lerner LB, McVary KT, Barry MJ. et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline Part II - Surgical evaluation and treatment. J Urol 2021; 206 (04) 818-826
    CrossrefPubMedGoogle Scholar
  • 55 Xu Z-W, Tian W, Zhou C-G, Leng B, Shi H-B, Liu S. Prostatic artery embolization for the treatment of recurrent lower urinary tract symptoms following transurethral resection of the prostate. J Vasc Interv Radiol 2021; 32 (02) 242-246
    CrossrefPubMedGoogle Scholar
  • 56 Kearns DJ, Boardman P, Tapping CR. Patterns of reperfusion and clinical findings in repeat prostate artery embolisation for recurrent lower urinary tract symptoms in patients with benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2021; 44 (01) 95-101
    CrossrefPubMedGoogle Scholar
  • 57 Costa NV, Torres D, Pisco J. et al. Repeat prostatic artery embolization for patients with benign prostatic hyperplasia. J Vasc Interv Radiol 2020; 31 (08) 1272-1280
    CrossrefPubMedGoogle Scholar
  • 58 Xu Z-W, Zhou C-G, Tian W, Shi H-B, Liu S. Long-term efficacy and recurrence prediction of prostatic artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2022; DOI: 10.1007/s00270-022-03272-2.
    CrossrefPubMedGoogle Scholar
  • 59 Braithwaite S, Boardman P, Tapping C, Macdonald A. Early total recanalization of the prostate artery and reperfusion of the prostate following particle embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2021; 32 (07) 1096-1098
    CrossrefPubMedGoogle Scholar
  • 60 Galla N, Maron SZ, Voutsinas N. et al. Adjunctive coil embolization of the prostatic arteries after particle embolization for prostatic artery embolization. Cardiovasc Intervent Radiol 2021; 44 (12) 1994-1998
    CrossrefPubMedGoogle Scholar
  • 61 Bulman JC, Sarwar A. Prostate artery embolization versus transurethral resection of the prostate: Is cost-effectiveness analyses useful to improve access to image-guided procedures in the United States?. J Am Coll Radiol 2022; 19 (06) 744-745
    CrossrefPubMedGoogle Scholar
  • 62 Ray Jr CE. Invited commentary: prostatic artery embolization versus transurethral resection of the prostate: a post hoc cost analysis of a randomized controlled clinical trial, by Capdevila et al. Cardiovasc Intervent Radiol 2021; 44 (11) 1778-1779
    CrossrefPubMedGoogle Scholar
  • 63 Carnevale FC, Moreira AM, Harward SH. et al. Recurrence of lower urinary tract symptoms following prostate artery embolization for benign hyperplasia: single center experience comparing two techniques. Cardiovasc Intervent Radiol 2017; 40 (03) 366-374
    CrossrefPubMedGoogle Scholar
  • 64 Bilhim T, Costa NV, Torres D, Pisco J, Carmo S, Oliveira AG. Randomized clinical trial of balloon occlusion versus conventional microcatheter prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2019; 30 (11) 1798-1806
    CrossrefPubMedGoogle Scholar
  • 65 Mahmoudi M, Jennings C, Pereira K, Hall AF, Arzani A. Guiding the prostatic artery embolization procedure with computational fluid dynamics. J Biomech Eng 2022; 144 (11) 111004
    CrossrefPubMedGoogle Scholar