Prostatic artery embolization for treatment of benign prostatic hyperplasia: ready for the clinical routine?

Abstract

Surgical treatment of benign prostatic hyperplasia (BPH) is recommended if the response to pharmaceutical treatment is insufficient. Due to the morbidity of established surgical methods, a number of minimally invasive procedures have been developed, including prostatic artery embolization (PAE). Improvements of micturition symptoms after PAE were first reported in 2000 but for a long time only limited evidence for PAE was available; however, a large, non-randomized registry-based study recently confirmed the safety and efficacy of PAE. Moreover, a randomized controlled trial was performed at the Cantonal Hospital in St. Gallen. In this study 103 men with refractory symptoms were randomized in a 1:1 manner to PAE or transurethral resection of the prostate (TUR-P). A marked improvement of BPH symptoms was found for both forms of treatment. Subjective complaints improved faster after TUR-P but significant differences between both treatment modalities were no longer present after 12 weeks. No differences were also found for other subjective parameters (e.g. quality of life and erectile dysfunction); however, there were significantly inferior functional results after PAE (e.g. maximum urinary flow rate, postvoid residual). In contrast, PAE showed significantly fewer treatment-related complications. Established surgical methods remain the first choice in the presence of BPH-related complications requiring a desobstructive effect. In the early stages of BPH, the patient’s expectations have to be taken into account and the advantages and disadvantages of PAE must be weighed up in consideration of the individual clinical situation. If PAE is performed it should be carried out within clinical trials whenever possible.