Comparison of PAE for BPH on Prostate gland size <80 g versus >80 g- retrospective review of short term to midterm outcomes in a single center

Wednesday, March 8, 2023

3:36 PM – 3:45 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

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

Interventional Radiology Resident
Jackson Memorial Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

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
AM

Aneesha Maini, n/a

Medical Student
University of Miami Miller School of Medicine
MA

Mohammed Aldajani, MD

Interventional Radiology Resident
Jackson Memorial Hospital
LR

Laniel Romeus, MD

Interventional Radiology Resident
Jackson Memorial Hospital
DH

Damian Hall, MD

Interventional Radiology Resident
Jackson Memorial Hospital
AB

Ansh Bhatia, n/a

Medical Student
KEM 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: PAE is a minimally invasive procedure for treating LUTS of prostatic origin. This study compares the efficacy and safety outcomes of PAE in baseline prostate volumes < 80 g versus >80 g.

Materials and Methods: 922 patients underwent PAE from April 2014 to August 2022 with gland size estimated by preprocedural MR or ultrasound. Patients were divided into “Group A” (n=251) with < 80g prostates and “Group B” (n=671) with >80g prostates. Mean age was 70 ± 9 years. Mean prostate volume was 58 ± 14 g in group A and 142 ± 62 g in Group B. Evaluation occurred at 3, 12, 24, 60-month (m) intervals following PAE. Changes in IPSS, QoL, and prostate volume were calculated. Nonresponse was defined as IPSS >13 after PAE. Adverse events were recorded using the Clavien-Dindo (CD) classification. Two-tailed P < 0.05 was considered significant.

Results: Median follow up was 1000 days (15 - 3087). Median baseline IPSS was 25 [IQR 21-29] in Group A and 22 [IQR 17- 27] in Group B (p< 0.01). Median baseline QoL was 5 [IQR 4-6] in Group A and 5 [IQR 4-6] in Group B (p=0.2). Table compares change in IPSS, QoL, % change in prostate size, and clinical nonresponse percentage after PAE. Although change in IPSS was similar, QoL and prostate size decreased more in group B patients at 3 and 12 m post PAE. A higher percentage of clinical nonresponse was identified in Group A (23%) compared to Group B (11%) early after PAE. 86 patients (34%) in Group A and 232 patient (35%) in Group B had self-limited CD grade 1 postoperative symptoms (frequency, urgency and dysuria) (p=0.6). 3 (0.3%) had CD grade 4 events, urosepsis and were treated with IV antibiotics. 3 TIAs occurred which resolved without intervention.

Conclusion: Patients with larger prostate glands at baseline have more decrease in prostate size and QoL, and lower incidence of persistent symptoms. However, PAE is safe and effective in reducing IPSS and improving QoL in prostate glands >80 g as well as those with glands < 80 g.