Prostate artery embolization in prostate glands greater than 80 grams- a single center experience

Wednesday, March 8, 2023

4:12 PM – 4:21 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

AM

Aneesha Maini, n/a

Medical Student
University of Miami Miller School of Medicine

Disclosure information not submitted.

Author/Co-author(s)

Andrew Richardson, MD MBA (he/him/his)

Interventional Radiology Resident
Jackson Memorial Hospital
Kenneth Richardson, MS-3

University of Miami Medical Student
University of Miami
KS

Khushi Shah, n/a

Medical Student
University of Miami Miller School of Medicine
HB

Howard Brent, MD

Interventional Radiology Resident
Jackson Memorial Hospital
JB

Joseph Boateng, MD

Interventional Radiology Resident
Jackson Memorial Hospital
AB

Amjad Bokhari, MD

Interventional Radiology Resident
Jackson Memorial Hospital
JK

Jessica G. Kumar, MD

Assistant Professor Clinical Interventional Radiology
Jackson Memorial Hospital
Hamed Jalaeian, MD, MS, RPVI

Assistant Professor Clinical Interventional Radiology
University of Miami Health System
Shivank Bhatia, MD

Professor of Interventional Radiology
University of Miami

Disclosure(s):

Andrew Richardson, MD MBA: No financial relationships to disclose

Kenneth Richardson, MS-3: No financial relationships to disclose

Hamed Jalaeian, MD: No financial relationships to disclose

Shivank Bhatia, MD: Embolx: Ownership Interest (Ongoing); Merit Medical: Contracted Research (Ongoing), Research Grant Recipient (Ongoing)

Purpose: To evaluate the safety and efficacy of prostate artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH) for prostate glands greater than 80 grams, a cohort of patients limited in management options given the prostate size.

Materials and Methods: 697 patients with prostate glands > 80 grams underwent PAE for BPH with lower urinary tract symptoms (LUTS) from April 2014 to August 2022. Mean patient age was 70.7 ± 9.3 years, mean prostate volume was 141.8 ± 62.0 g, median (IQR) pre-procedure IPSS and Quality of Life (QoL) were 22 (IQR, 17-27) and 5 (IQR, 4-6), respectively. 575 PAE procedures (82.5%) were performed through radial access. Patients were evaluated at 3, 12, 24, 60-month intervals following PAE. Adverse events were recorded using the Clavien-Dindo (CD) classification. A two-tailed P < 0.05 was considered significant.

Results: The study population was followed up for a median of 963 days (range, 29-3111). 3 months post PAE median IPSS decreased to 5 (IQR, 3-9) (n= 368, p < 0.01), median QoL improved to 1 (IQR, 0-2) (n= 364, p< 0.01), and mean prostate size decreased to 92.2 ± 42.0 g (p < 0.01). At 12 months after PAE median IPSS was 6 (IQR, 3-11) (n=191, p < 0.01), median QoL was 1 (IQR, 0-2) (n=192, p< 0.01) and mean prostate size was 92.3 ± 45.1 g (n= 127, p < 0.01). At 24 months, median IPSS was 7 (IQR, 3-14) (n=73, p < 0.01), median QoL was 2 (IQR, 0-3) (n=73, p< 0.01), and mean prostate size was 107.2 ± 47.0 g (n= 47, p < 0.01). 5-years post PAE median IPSS was 3 (IQR, 2-11) (n=25, p< 0.01), median QoL was 1 (IQR, 0-2) (n=23, p< 0.01), and mean prostate size was 71.8 ± 14.4 g (n= 5, p < 0.01). A total of 44 patients (6.3%) required a second procedure for recurrent BPH symptoms during follow-up; 7 underwent a second PAE procedure. 34.2% of patients had self-limited CD grade I postoperative symptoms, most common being frequency, urgency, and dysuria. 3 patients (0.43%) developed urosepsis after PAE (CD grade IV) and were treated with IV antibiotics.

Conclusion: PAE is a safe and clinically effective procedure for BPH with LUTS in non-index prostate sizes ( >80g) with great short-term to midterm results. Individuals continue to report promising long-term outcomes, including maintained relief of LUTS and significant improvement in QoL.