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Study finds PAE “highly effective” long-term treatment for enlarged prostate, 1st March 2023, Shivank Bhatia, MD
Prostate artery embolization (PAE) provides long-term effectiveness in treating urinary symptoms from an enlarged prostate gland, according to new research to be presented at the Society of Interventional Radiology (SIR) annual scientific meeting (4–9 March, Phoenix, USA).
In the largest long-term North American study, 1,000 patients who underwent PAE reported significant sustained relief, up to six years, from lower urinary tract symptoms (LUTS) or urinary retention due to benign prostate hyperplasia (BPH).
“Our study shows that PAE is a highly effective treatment whose long-term outcomes include sustained LUTS relief and significant improvement in quality of life,” said senior author Shivank Bhatia, chair of Interventional Radiology (IR) at the University of Miami Miller School of Medicine (Miami, USA). “Of 18 million men in the USA eligible for BPH treatment, many avoid all treatments because of the widely known risks of surgery, particularly sexual side effects and leakage. PAE avoids these risks while achieving long-term clinical results.”
With PAE, interventional radiologists inject tiny particles into arteries that feed the prostate gland, reducing its blood supply and thereby shrinking it. Researchers characterised the treatment as showing “great short- to mid-term results” and positive long-term outcomes in self-reported symptom relief. In a media briefing organised by SIR ahead of the annual meeting, Bhatia responded to a question on the nature of the particle used for his six-year study—”they are acrylic polymer coated with gelatine”. He added that while the particles are permanent, as opposed to resorbable, they carry a positive charge, where blood is negative, thereby ensuring that they do not move through the bloodstream “to the brain, but stay within the organ itself”.
Participants reported dramatic improvements on the 35-point International Prostate Symptom Score, which ranks symptoms as mild, moderate or severe. Preprocedure, patients reported a mean score of 23, in the “severe” range. But in less than a year, they achieved a score of six, with “mild” symptoms persisting throughout the six-year study – a response similar to that following surgery for BPH. However, PAE does not negatively impact sexual function. Study participants were also asked a quality-of-life question: “If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?” Preprocedure, the mean score was 5 or “mostly dissatisfied,” but within a year, the score was 1, or “mostly satisfied,” a ranking that also continued throughout.
PAE has a well established safety profile, as shown in repeated studies in the 10 years since it was first used. But interventional radiologists said most men are unaware of this treatment option. Most will avoid surgery and may instead take medication for years, even as BPH worsens, potentially leading to bladder failure.
“Patients choose PAE to avoid the side effects of current medications for BPH, which can include erectile dysfunction, painful or difficult urination, constipation, dizziness or fatigue,” said the study’s lead author Andrew Richardson, a senior resident at Jackson Memorial Hospital (Miami, USA). “PAE is an alternative not just to surgery but also to lifelong medication.”
Among the study’s findings was a persistent, years-long reduction in prostate size. However, Bhatia noted that prostate size reduction is not the only goal in long-term effectiveness. “Treatment should make the prostate softer as well as smaller – as opposed to smaller but remaining hard, which will still cause urinary symptoms.”
Bhatia and Richardson encourage patients to learn about all options for enlarged prostate symptoms, talk to various physicians and then decide what is best for them. Bhatia says, “One size does not fit all when it comes to treating BPH.”