Effectiveness and safety of prostatic artery embolization for the treatment of lower urinary tract symptoms from benign prostatic hyperplasia in men with concurrent localized prostate cancer

J Vasc Interv Radiol. 2021 Mar 29;S1051-0443(21)00938-6. doi: 10.1016/j.jvir.2021.03.534. Online ahead of print.

Abstract

Purpose: To assess clinical effectiveness and safety of prostatic artery embolization (PAE) on lower urinary tract symptoms (LUTS) in the setting of localized prostate cancer (PCa).

Materials and methods: This was a retrospective, single-center, institutional review board-approved study from December 2016 through June 2020 of 21 patients (median age 72, range 63-83) with moderate LUTS and localized PCa. Clinical effectiveness was evaluated at 6 and 12 weeks by IPSS and QoL improvement. 17 patients were scheduled to receive definitive radiotherapy (RT) after PAE; 13 patients completed RT. Short term imaging signs of oncologic progression were evaluated at 6 and 12 weeks defined by at least one of the following on MRI: increased PIRAD score of index lesion(s) to at least 4; new extra-capsular extension, seminal vesicle involvement or pelvic lymphadenopathy. Nonparametric Wilcoxon Signed Rank test was used for analysis.

Results: IPSS improved by median 12 (n=19, p<0.0001) at 6 and 14 (n=14, p<0.0001) at 12 weeks, respectively, and QoL improved by median 2 (n=19, p<0.0001) at 6 and 3 (n=3, p<0.0001) at 12 weeks. Prostate volume reduction was median 24% (n=19, p<0.0001) at 6 and 36% (n=12, p=0.015) at 12 weeks, respectively. No patients demonstrated imaging disease progression at 6 (n=16) or 12 (n=8) weeks. Median time from PAE to RT was 90 days. No patients experienced increased PSA post-RT or grade 3 or greater GU toxicity.

Conclusion: PAE is clinically effective and safe for treatment of men with LUTS and BPH in the setting of concomitant, localized, non-obstructive PCa.